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Systematic Reviews
Functional social support andcognitive
function inmiddle- andolder-aged adults:
asystematic review ofcross-sectional
andcohort studies
Lana Mogic1, Emily C. Rutter1, Suzanne L. Tyas1, Colleen J. Maxwell1, Megan E. O’Connell2 and Mark Oremus1*
Abstract
Background Intact cognitive function is crucial for healthy aging. Functional social support is thought to protect
against cognitive decline. We conducted a systematic review to investigate the association between functional social
support and cognitive function in middle- and older-aged adults.
Methods Articles were obtained from PubMed, PsycINFO, Sociological Abstracts, CINAHL, and Scopus. Eligible
articles considered any form of functional social support and cognitive outcome. We narratively synthesized extracted
data by following the Synthesis Without Meta-Analysis (SWiM) guidelines and assessed risk of bias using the Newcas-
tle–Ottawa Scale (NOS).
Results Eighty-five articles with mostly low risk-of-bias were included in the review. In general, functional social
support—particularly overall and emotional support—was associated with higher cognitive function in middle- and
older-aged adults. However, these associations were not all statistically significant. Substantial heterogeneity existed
in the types of exposures and outcomes evaluated in the articles, as well as in the specific tools used to measure
exposures and outcomes.
Conclusions Our review highlights the role of functional social support in the preservation of healthy cognition in
aging populations. This finding underscores the importance of maintaining substantive social connections in middle
and later life.
Systematic review registration Rutter EC, Tyas SL, Maxwell CJ, Law J, O’Connell ME, Konnert CA, Oremus M. Asso-
ciation between functional social support and cognitive function in middle-aged and older adults: a protocol for a
systematic review. BMJ Open;10(4):e037301. https:// doi. org/ 10. 1136/ bmjop en- 2020- 037301
Keywords Cognitive function, Functional social support, Systematic review
Background
Maintaining cognitive function is crucial for healthy
aging [1–3]. erefore, identifying and exploring modifi-
able risk or protective factors for cognitive function are
key foci of aging research [4]. Social support is an impor-
tant modifiable protective factor for cognitive function
[5–8].
*Correspondence:
Mark Oremus
moremus@uwaterloo.ca
1 School of Public Health Sciences, Faculty of Health, University
of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada
2 Department of Psychology, University of Saskatchewan, 9 Campus
Drive, 154 Arts, Saskatoon, SK S7N 5A5, Canada
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Page 2 of 31
Mogicetal. Systematic Reviews (2023) 12:86
Structural social support is a quantifiable measure
of social relationships, such as the number of people in
one’s social network or the degree of participation in
social events. Functional social support is the extent to
which an individual perceives their needs can be met by
members of their social network, such as the availability
of someone to drive them to the doctor or help with gro-
cery shopping, if required [9, 10].
Multiple reviews reported that large social networks
and frequent engagement with these networks pro-
mote cognitive stimulation and protect against cognitive
decline [11–14]. However, the literature has devoted less
attention to functional social support and cognitive func-
tion, even though functional support more accurately
represents the depth and quality of social support experi-
enced by individuals than structural support [9].
Kelly etal. reviewed the association between functional
social support and cognitive function in nine longitudinal
studies of healthy older adults [15]. ey reported vari-
ability in the direction and magnitude of the association,
depending on the measures of functional support and
cognitive function. Since Kelly etal.’s review [15], addi-
tional literature [6, 7, 16, 17] has emerged on the topic,
underlining the need for an updated review.
We conducted this systematic review to investigate
the association between functional social support and
cognitive function across multiple cognitive domains
(i.e., memory, executive function) and cognitive disease
states (i.e., mild neurocognitive disorder, major neuro-
cognitive disorder) in middle-aged and older adults. Our
review focused exclusively on functional social support,
reflecting Menec et al.’s conceptual distinction between
objective (structural) and subjective (functional) social
relationships: one may report many social contacts yet
believe most will not help in times of need, or vice versa
[18]. Importantly, this review differs from Costa-Cordella
et al.’s recently published review [19], which included
articles on structural and functional social support with-
out age restrictions and excluded articles on neurological
conditions characterized by cognitive deficits (e.g., mild
or major neurocognitive disorder).
Methods
Our review followed the 2020 Preferred Reporting Items
for Systematic Reviews and Meta Analyses (PRISMA)
guidelines [20] (Additional file1). We departed slightly
from our published protocol [4] and did not conduct a
meta-analysis or formally assess publication bias, nor did
we narratively synthesize the extracted data by sex, set-
ting, or risk of bias level. ese proposed undertakings
were precluded by heterogeneity in definitions and meas-
ures of functional social support and cognitive function,
as well as by multiple different means of reporting quan-
titative results in the included articles.
Data sources andsearches
We searched PubMed, PsycINFO, Sociological Abstracts,
CINAHL and Scopus from inception to September 2021.
Google Scholar was searched to retrieve grey litera-
ture. A medical librarian generated the syntax for Pub-
Med (Additional file2), which was adapted for the other
databases.
Eligibility criteria
e review included any study with a comparison group
(e.g., cohort, cross-sectional, case–control) enrolling
adults aged ≥ 40years, regardless of residential setting
(e.g., community, long-term care facility). Articles had
to be published in English or French and report distinct
results for persons in the age range of interest. e expo-
sure was functional social support, sometimes called
‘perceived social support’ or ‘social support availability’,
and the outcome was cognitive function. Included arti-
cles could assess global/overall functional social support
or a subtype, such as emotional/informational support,
tangible support, affectionate support, positive social
interaction, using any tool or questionnaire. Similarly,
the articles could measure cognitive function globally or
by domain (e.g., memory, executive function) with any
instrument or combination of tools (neuropsychological
battery). We also included studies of neurological con-
ditions characterized by cognitive deficits (e.g., mild or
major neurocognitive disorder).
In line with the PICOS (population, intervention, com-
parator, outcome, and setting) framework, we present the
inclusion criteria as follows:
• P = Adults aged 40years or over from any residential
setting, including those residing in the community
or independent-living older age homes, or persons
residing in institutionalized settings such as long-
term care facilities;
• I = Any level of exposure to functional social support,
defined broadly as one’s perception of the amount of
help they would expect to receive from members of
their social network in times of need;
• C = A different level of functional social support rela-
tive to ‘I’ above, e.g., comparing persons with lower
scores on a social support scale (C) to persons with
higher (better) scores on the scale (I);
• O = Any measure of differences between I and C,
such as differences in cognition scale score or differ-
ences in the incidence or prevalence of a neurological
condition; and
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Mogicetal. Systematic Reviews (2023) 12:86
• S = Study conducted anywhere in the world and in
any setting.
We excluded articles that did not assess any form of
functional social support, cognitive function, or neu-
rological condition with cognitive deficits. We also
excluded articles that did not include comparison
groups or articles published in languages other than
English or French.
Study selection, data extraction andrisk ofbias
assessment
Following removal of duplicates, two reviewers used
the eligibility criteria and Covidence software (Veri-
tas Health Innovation, Melbourne, Australia) to inde-
pendently screen the titles/abstracts and full texts
of identified citations. Two reviewers independently
extracted the following data from included articles into
a prepared Excel spreadsheet: first author, year of pub-
lication, country of data collection, proportion female,
setting, length of follow-up, type and measure of social
support, type and measure of cognitive function, and
outcomes. Reviewers extracted outcome data in the
form reported by authors. Where possible, extracted
data came from fully adjusted regression models. Two
independent reviewers assessed risk of bias using the
Newcastle–Ottawa Scale (NOS) [21]. In all cases, dis-
crepancies between reviewers were resolved by consen-
sus or a third reviewer.
Synthesis methods
e extracted data were narratively synthesized in groups
based on cognitive outcome, study design, and functional
social support subtype. Studies of visuospatial skills or
reasoning were classified under executive function; those
of verbal memory, non-verbal memory, working mem-
ory, or episodic memory were classified under memory;
and those of attention or processing speed were placed
in their own unique category. We followed the Synthesis
Without Meta-Analysis (SWiM) guidelines to conduct a
narrative synthesis [22] and reported the effect measures
contained in the included articles.
Results
Study characteristics
Our search yielded 2,976 articles and 85 of these articles,
published between 1986 and 2021, were included in the
review (Fig. 1). Of these 85 articles, 44 were cross-sec-
tional and 41 were cohort studies, with sample sizes rang-
ing from 20 to 30,029 (Table1). Most samples included
community-dwelling persons, but four studies exclusively
enrolled persons in institutionalized settings [23–26].
Nineteen articles examined dementia due to Alzheimer’s
disease (AD) or all-cause dementia, 38 examined global
cognitive functioning or general cognitive impairment
or decline, and 20 examined specific cognitive domains.
Sixty-two articles reported multiple subtypes of func-
tional social support. Common control variables were
age, sex, race, education, income, social network, marital
status, activities of daily living (ADLs), depression, and
Fig. 1 PRISMA Flow Diagram
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Page 4 of 31
Mogicetal. Systematic Reviews (2023) 12:86
Table 1 Study characteristics
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Cross-Sectional
Alpass et al., 2004 [27] 232 1.29 (3/232) 53.8 to 95.2 Community- dwelling MMSE Hierarchical regression
analysis Age, education, income,
social network, depres-
sion
Bourgeois et al., 2020 [23] 359 15% > 50 Institutionalized (HIV
clinic) MoCA Poisson regression
analysis Age, sex, education,
income, marital status,
ethnicity, tobacco use,
employment
Bourne et al., 2007 [28] 266 50 (134/266) 64 Community- dwelling MHT (in 1947); Raven’s
standard progressive
matrices (at age 64)
Bivariate correlation Sex
Conroy et al., 2010 [29] 802 53% (423/802) 65 to 102 Community- dwelling AMT Multinomial odds ratio Education, social
network, marital status,
loneliness, depression
Deng & Liu, 2021 [30] 10,556 55.26% ≥ 65 years Community- dwelling
and institutionalized Chinese-MMSE Multivariate logistic
regression Age, sex, education,
income, marital status,
area of residence
Ficker et al., 2002 [24] 194 71.60% NR Institutionalized MDRS Independent t-test Race, education
Frith & Loprinzi, 2017 [31] 1874 59.10% 60 to 85 Community- dwelling WAIS: DSST Weighted multivariable
regression Age, sex, race
Ge et al., 2017 [32] 3159 58.90% 60 to 105 Community- dwelling Chinese-MMSE, EBMT,
SDMT, Digit Span Back-
wards Test
Linear regression
analysis Education, income, social
network, marital status,
ADLs, depression
Gow et al., 2007 [33] 488 58% NR Community- dwelling MHT—raw MHT scores
converted into IQ
scores
Regression analysis Age, education, income,
marital status, loneliness
Gow et al., 2013 [34] 1091 NR NR (mean age 70) Community- dwelling WAIS-III UK and WMS-III
UK, tests of reaction
and inspection time
Ancova Social network, marital
status, loneliness, depres-
sion
Hamalainen et al., 2019 [35] 30, 029 50.90% 45 to 85 Community- dwelling Mental Alternation Test,
Animal Fluency test,
Controlled Oral Word
Association Test, Stroop
test, RAVLT with imme-
diate and 5-min recall
Multiple regression
analysis Age, sex, race, education,
income
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Harling et al., 2020 [36] 5059 53.6% ≥ 40 Community- dwelling Battery from Health
and Retirement study
(orientation in time,
episodic memory, num-
ber patterns)
Poisson regression;
linear regression Age, sex, education,
income, marital status,
country of origin, self-
reported literacy, self-
rated childhood health,
father’s occupation,
household size, employ-
ment status
Henderson et al., 1986 [37] 274 NR 70–79
80 + Community- dwelling GMS; MMSE Mancova Age, sex, marital status
Holtzman et al., 2004 [38] 354 68.60% 50 to 81 Community- dwelling MMSE Simultaneous linear or
logistic
Regression
Age, sex, race, education,
depression
Jang et al., 2020 [39] 2061 66.8% ≥ 60 Community- dwelling Korean-MMSE; self-
rated cognitive health Bivariate regression;
hierarchical linear
regression
Age, sex, education,
social network, marital
status, depression,
chronic conditions (func-
tional disability, chronic
disease), tobacco use,
alcohol use
Keller- Cohen et al., 2006 [40] 20 15/20 85–93 Independent living in
retirement community composite cognistat;
BNT Hierarchical multiple
Regression; bivariate
correlation
Education
Kim et al., 2019 [41] 410 252/410 60 + Community- dwelling VMS; CERAD-TS; MMSE One-way ANCOVA Age, sex, education,
depression
Kotwal et al., 2016 [42] 3310 52% 62 to 90 Community- dwelling MoCA-SA Multiple linear regres-
sion Age, sex, race, education,
marital status, depression
Krueger et al., 2009 [43] 838 75(NR/883) NR Subsidized housing
facilities and con-
tinuous care retirement
communities
Episodic: Word List
Memory, Recall, and
Recognition; WMS;
Semantic: BNT, National
Adult Reading Test;
Working: Digit Span
Forward and Backward,
Digit Ordering
Linear regression
analysis Age, sex, education,
depression
La Fleur & Salthouse, 2017 [44] 2613 18–39: 66
40–59: 72
60–96: 63
NR ND Logical memory task;
free recall task; paired
associates’ task; Letter
sets task; Shipley’s
Abstraction; matrix
reasoning
Multiple regression Age, sex, education
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Lee & Waite, 2018 [45] 2260 52.05 57–85 Community–dwelling MoCA-SA Multivariate regression Age, sex, race, education
Mehrabi & Béland, 2021 [46] 1643 50.2% ≥ years Community–dwelling MoCA Regression Age, sex, education,
income, smoking, alcohol
consumption, sleeping
disturbance
Millán-Calenti et al., 2013 [47] 579 57.2 ≥ 65 years Community–dwelling
residents MMSE; The Geriatric
Depression Scale-Short
Form
Multinomial logistic
regression Age, sex, education, ADLs
Murayama et al., 2019 [48] 897 50 (450/897) ≥ 65 years Community- residents MMSE-J Multilevel logistic
regression Age, sex, education,
income, social network,
marital status
Nakamura et al., 2019 [49] 331 100 (331/331) ≥ 65 years ND BOMC Unadjusted bivariate
analysis Age, education, ADLs,
depression
Okabayashiet al., 2004 [50] 1976 NR ≥ 65 years ND Japanese-SPMSQ Regression (unspeci-
fied) Age, sex, education,
depression
Oremus et al., 2019 [6] 21,241 51% 45–85 ND RAVLT, Animal Fluency
Test, Mental Alterna-
tion Test
Rao-Scott chi square Age, region of residence,
urban / rural residence,
education
Oremus et al., 2020 [7] 21,241 51.3 (10,835/21241) 45–85 ND RAVLT Multiple linear regres-
sion Age, sex, education,
income, marital status,
ADLs, depression
Pillemer & Holtzer, 2016 [51] 355 55.2 (196/355) 65.00- 95.00 Community- dwelling RBANS Linear regression
analysis Age, sex, education,
depression
Poey et al., 2017 [52] 779 58 (452/779) 70–110 years ND Diagnosis of normal
cognition, CIND, AD,
and non-AD dementia
Multiple logistic regres-
sion Age, sex, race, education,
depression
Rashid et al., 2016 [53] 2005 68 (1363/2005) 60–99 Community- dwelling ECAG Regression Analyses Age, sex, race, education,
social network, marital
status
Saenz et al., 2020 [54] 4,017 (mar-
ried dyads) 50% (4017/8034) 50 + Community- dwelling Cross-Cultural Cogni-
tive Examination Regression analysis Age, sex, education,
income, ADLs, depres-
sion
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Sims et al., 2014 [55] 175 45% 54–83 Community- dwelling Stroop Color-Word
Test, Judgment of Line
Orientation; WAIS-R:
The Block Design
subscale, Digit Span
Forward, Digit Span
Backward; WMS: Logical
Memory I and II Visual
Reproductions I and II;
The Grooved Pegboard,
TMT
Multiple regression Age, sex, race, education,
depression
Weng et al., 2020 [56] 1706 53.01% ≥ 45 years Community- dwelling Subjective cognitive
decline Univariate and multiple
logistic regression Age, sex, race, education,
marital status, depres-
sion, chronic conditions
(coronary heart disease,
diabetes), exercise,
employment status
Yang et al., 2020 [57] 470 52.6% ≥ 65 years Community- dwelling CDR; MMSE Multiple linear regres-
sion Age, sex, educa-
tion, income, ADLs,
depression, functional
assessment question-
naire, neuropsychiatric
inventory questionnaire
(nighttime behaviors,
irritability, apathy, motor
disturbances)
Yeh & Liu, 2003 [58] 4993 46.67% ( 2330/4989) 65 + Community- dwelling SPMSQ Multiple regression
analysis Sex, education, marital
status, loneliness, ADLs
Zahodne et al., 2014 [59] 482 54.1 55–85 Community- dwelling NIH Toolbox Cognition
module: Dimensional
Change Card Sort,
Flanker, List Sorting,
Pattern Comparison,
Picture Sequence
Memory
Regression analysis Race, education, loneli-
ness
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Zahodne et al., 2018 [60] 548 62.6 ND Community- dwelling NIH Toolbox Cognition
module: Dimensional
Change Card Sort,
Flanker, List Sorting,
Pattern Comparison,
Picture Sequence
Memory, Selective
Reminding Test. Lan-
guage scores, Benton
Visual Retention Test,
the Rosen Drawing Test,
and the Identities and
Oddities subtest of the
DRW
Multiple regression Race, education, income
Zank & Leipold, 2001 [61] 63 76% 53–96 Geriatric day care units MMSE Hierarchical regression
analysis Education, marital status
Zhaoyang et al., 2021 [62] 311 67% 70–90 Community- dwelling 5 cognitive domains
(memory, executive
function, attention,
language, visual-spatial)
with 10 neuropsycho-
logical instruments
Multilevel Poisson and
logistic models Age, sex, race, education,
employment, marital
status, living status
Zhu et al., 2012 [63] 120 37.50% 60–86 Community- dwelling MMSE Multiple regression
analysis Age, sex, education,
income, social network,
marital status,
Zuelsdorff et al., 2013 [64] 623 71% 40–73 Community- dwelling RAVLT, Digits Forward,
Digits Backward;
WAIS-III: Letter-Number
Sequence subtests;
TMT, and Stroop Color-
Word
Regression analysis Age, sex, education,
social network, marital
status
Zuelsdorff et al., 2019 [65] 1052 69% 40–78 Community- dwelling RAVLT; BVMT-R; WAIS-R:
Logical Memory imme-
diate and delayed recall
subtests; TMT, Stroop;
Color-Word Interfer-
ence condition; WAIS:
Digit Span Forward,
Digit Span Backward,
and Letter-Number
Sequencing
Regression analysis Age, sex, race, education,
social network, marital
status, ADLs
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Zullo et al., 2021 [66] 1567 58.65% ≥ 65 years Community- dwelling Questionnaire de la
Plaite Cognitive (QPC) Binary logistic regres-
sion Age, sex, depression,
personality dimensions,
quality of life, profes-
sional activity, interaction
term between neuroti-
cism and quality of life
Cohort
Amieva et al., 2010 [67] Study
sample
size = 3777,
Analytic/
included
sample: 2089
59.9% (1251/2089) ND Community- dwelling AD / Dementia diagno-
sis; MMSE; NINCDS-
ADRDA criteria for AD
Multivariate analysis Sex, education, social
network, ADLs, Diabetes,
CVD
Andel et al., 2012 [68] 10,106 52% ND Community- dwelling Dementia diagnosis
using DSM-4 criteria Regression analysis Age, sex, education,
vascular disease
Bedard & Taler, 2020 [69] 11,152 (440
cases, 10,712
controls)
Controls: 55.3%
Cases: 42.1 – 44.9% 45–85 NR Animal Fluency Test,
controlled oral word
association test, mental
alternation test, and
Victoria Stroop test, Ray
auditory verbal learning
test, Miami prospective
memory test
Binary logistic regres-
sion Age, sex, education, mari-
tal status, depression,
testing language
Bowling et al., 2016 [70] 9119 50.69% (4622/9119) ND Community- dwelling Reading and compre-
hension test, arithmetic
test, copying design
test, general ability test
Multiple linear regres-
sion Sex, education, social
network, marital status
Camozzato et al., 2015 [71] 220 70% ND Community- dwelling DSM5 and NINCDS-
ADRDA criteria Multivariate cox
proportional- hazards
moel
Age, sex, education,
income, marital status,
ADLs
Chen & Chang, 2016 [72] 2300 44.87% 65–93 Community- dwelling SPMSQ; Chinese-MMSE Multinomial logistic
regression Age, sex, education,
ADLs, hypertension,
diabetes, heart disease,
stroke
Chen & Zhou, 2020 [73] 16, 786 NR ≥ 65 years Community- dwelling Chinese-MMSE Generalized structural
equation modelling
(GSEM)
Age, sex, education, mari-
tal status, cardiometa-
bolic diseases (diabetes,
cardiovascular, stroke,
heart disease), residence
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Crooks et al., 2008 [25] initial = 2249 100% ND Institutionalized Telephone Interview
for Cognitive Status;
Telephone Dementia
Questionnaire
Cox proportional
hazards Age, sex, education,
social network, marital
status, depression, stroke,
myocardial infarction,
diabetes, hypertension,
PD
Dickinson et al., 2011 [74] 213 63.85% Community- dwelling CERAD; WMS-R; Logical
Memory subtest; TMT,
SDMT; WAIS-R: Digit
Span Forward; ascend-
ing Digit Span task
modeled after the Digit
Ordering Test
Linear regression
models Age, sex, education,
social network
Eisele et al., 2012 [75] 2367
(1869 = ana-
lytic sample)
65.90% 79–95 Community- dwelling SIDAM Multifactorial ANCOVA Age, sex, education,
marital status, ADLs,
hypertension, CVD,
coronary heart disease,
alcohol use, BMI
Ellwardt et al., 2013 [76] 2255 54.00% 55–85 Community- dwelling MMSE; coding task,
and Reven’s Colored
Progressive Matrices
Latent growth media-
tion model Age, sex, education,
loneliness, ADLs
Heser et al., 2014 [77] 2300 ND ND Community- dwelling SIDAM Proportional hazard
models, cox regression
analysis
Age, sex, education, ADLs
Holtzman et al., 2004 [38] 354 68.60% 50–81 Community–dwelling MMSE Simultaneous linear
regression Age, sex, race, education,
social network
Howrey et al., 2015 [78] 2767 58.29% ND Community- dwelling MMSE Multivariate analyses
by using simultane-
ous linear or logistic
regression
Age, sex, education,
income, marital status,
ADLs, hypertension,
heart attack, stroke,
diabetes, vision, Nativity,
BMI
Hudetz et al., 2010 [26] 80 0% 55–85 Institutionalized RBANS: Story Memory
and Word List Memory
subtests; BVMT-R
Stepwise multiple
regression analysis Age, sex, education,
hypertension, hyper-
cholesterolemia, angina,
myocardial infarction,
type 2 diabetes
Hughes et al., 2008 [79] at base-
line = 417,
ana-
lytic = 217
51.80% ND Community- dwelling MMSE; Stroop test, TMT,
Hopkins verbal learning
tests
Random effects model Age, sex, education,
social network, marital
status
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Kats et al., 2016 [80] 13,782 ND 48–64 Community- dwelling DSST, DWRT, WFT Generalized linear
models Age, sex, race, education,
social network
Khondoker et al., 2017 [81] 10,055 46% ND Community- dwelling The short-form IQCODE
questionnaire and
physician
Proportional hazard
regression models Age, sex, education,
income, diabetes, CVD,
stroke, hypertension,
cancer
Khoo & Yang, 2020 [82] 1735 NR 40–70 NR Brief Test of Adult Cog-
nition by Telephone
(BTACT)
Structural equation
modelling Age, sex, education,
income, general health
Liao et al., 2018 [83] 6,863 29.20% ND Community- dwelling Alice Heim 4-I test
(AH4-I), an inductive
reasoning test, and two
tests of verbal fluency
Bivariate dual change
score model; goodness
of fit
Age, sex, race, education,
income, marital status,
coronary heart disease,
stroke, diabetes, cancer,
depressive symptoms
Liao & Scholes, 2017 [84] 10,241 53.30% ND Community- dwelling Verbal fluency and let-
ter cancellation task Linear mixed model Age, sex, education,
income, ADLs
Liu et al., 2020 [85] 13, 636 55% ≥ 65 years Community- dwelling Dementia Scale
(Degree of Independ-
ence in Daily Living
for Older Adults with
Dementia)
Multivariate adjusted
Cox proportional
hazards model
Age, sex, education,
history of disease (stroke,
hypertension, myocar-
dial infarction, diabetes,
cancer), smoking, alcohol
drinking, BMI, time spent
walking per day, psy-
chological distress score,
motor function score,
social participation
Luo et al., 2021 [86] 497 48% 64–68 NR Subtest of verbal com-
prehension index in
German WAIS-R; verbal
fluency and vocabulary;
subtest of perceptual
reasoning index in
WAIS-R
Mplus8 NR
Miyaguni et al., 2021 [87] 15, 313 51.80% ≥ 65 years Community- dwelling I to IV and Medical,
I (= 22 on MMSE), II
(= 16), III (= 13), IV (= 6)
Multilevel survival
analyses with sensitivity
analyses model
Age, sex, education, mari-
tal status, depression,
living conditions, present
illness, smoking status,
alcohol consumption,
individual social support
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Moreno et al., 2022 [88] 2242 100% 65–83 NR Primary Mental Abili-
ties Vocabulary Test;
Category Fluency Test;
Letter Fluency Test;
Benton Visual Retention
Test; California Verbal
Learning Test; California
Verbal Learning Test;
Digit Span Test; Card
Rotation Test
Linear mixed models
with covariate adjust-
ment
Age, race, education,
income, region, job clas-
sification, major medical
comorbidities
Murata et al., 2019 [16] 14,088 50.97% 65–99 Community- dwelling Incident dementia
ascertained upon eligi-
bility for Japan’s public
LTCI system, Level II or
higher, on the index for
the evaluation of care
needs for people with
dementia
Cox proportional
hazard models Age, sex, education,
marital status, health
behaviors (alcohol, smok-
ing daily physical activ-
ity), cognitive complaints
to predict dementia,
depression
Noguchi et al., 2019 [89] 121 (analytic
sample) 47.10% ND Community- dwelling Japanese MoCA Multivariable
Linear regression
analysis
Age, sex, income, ADLs,
stroke, hypertension,
dyslipidemia, diabetes,
depression, living alone,
BMI
Okely et al., 2021 [90] 70–84 Community- dwelling 5 questions about cur-
rent state of partici-
pants’ memory
Spearman’s rho Age, sex, education,
depression, diabetes,
cardiovascular disease,
occupational social class,
personality, living situa-
tion, anxiety, older age
fluid cognitive ability
Pais et al., 2021 [91] 341 57.5% 60–85 Community- dwelling MMSE Multivariable Cox
analysis of social
support on cognitive
impairment (hazard
ratio)
Age, sex, social network,
marital status,
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Mogicetal. Systematic Reviews (2023) 12:86
Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Pillemer et al., 2019 [17] 493 57.20% 65–95 Community- dwelling RBANS Cox proportional
hazard ratio Sex, race, education,
diabetes, chronic heart
failure, arthritis, hyperten-
sion, depression, stroke,
Parkinson’s disease,
chronic
obstructive lung disease,
angina, myocardial
infarction, depressive
symptoms
Riddle et al., 2015 [92] 299 normal = 59.43%,
MCI = 57.89%, demen-
tia = 70.83%
ND Community–dwelling Neuropsychologi-
cal battery to detect
incident dementia or
cognitive impairment
Χ2 for categorical
variables and ANOVA,
logistic regression
models
Age, sex, race, education,
ADLs, depression
Rote et al., 2021 [93] 2880 57.7% ≥ 65 years Community- dwelling MMSE Logistic regression Age, sex, country of birth
(Mexico or USA), Medic-
aid (yes or no)
Saito et al., 2018 [94] 13,984 50.90% ND Community- dwelling Long-term Care Insur-
ance, The Degree of
Autonomy in the Daily
Lives of Elderly
Individuals with
Dementia Scale
Cox proportional
hazard models Age, sex, education,
income, social network,
marital status, ADLs,
stroke, diabetes, depres-
sion, SCI, physical activity
Salinas et al., 2017 [95] 1834 (for
dementia
analysis)
44% Community- dwelling DSM-IV Cox proportional
hazard models Age, sex, education,
social network, marital
status, atrial fibrillation,
diabetes, CVD, smoking
status, depression, physi-
cal activity, antihyperten-
sive treatment
Seeman et al., 2001 [96] 1189 55.20% 70–79 Community- dwelling BNT; WAIS-R Multivariate linear
regression Age, sex, race, education,
income, social network,
marital status, physical
activity
Sörman et al., 2015 [97] 1715 No Dementia: 53.3%
all cause dementia:
65.1%
AD: 73.9%
Community- dwelling DSM-IV Multivariate linear
regression Age, sex, education, CVD,
stroke, HBP, diabetes,
alcohol use, smoking
status, obesity, stress,
depression
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Table 1 (continued)
Author (Year) Sample Size Prop. Female Age Range Setting Cognitive Outcome
Measure Analysis Method Covariates
Thomas & Umberson, 2018 [98] 2,788 64.70% 60–95 Community- dwelling SPMSQ Estimated growth
curve models within a
mixed-model frame-
work Intercept (SE),
Linear Slope
Age, sex, race, education,
income, marital status,
number of children,
stressful life events
Wilson et al., 2015 [99] 529 78.90% Institutionalized and
community- dwelling Clinical classification
of MCI Proportional hazards
model Age, sex, education,
social network, loneli-
ness, depression, nega-
tive life events
Yin et al., 2020 [100] 5897 51% ≥ 65 years Community- dwelling MMSE Multivariable Cox
regression (hazard
ratio)
Age, sex, education,
income / occupation,
ADLS, residence, partici-
pation in physical activity,
smoking, drinking, nega-
tive well-being, baseline
MMSE, leisure activities,
physical diseases
Zahodne et al., 2019 [101] 8,538 56.24% 45–93 Community- dwelling Consortium to Establish
a Registry for Alzhei-
mer’s Disease Word List;
Tests of semantic and
letter fluency
Multivariate-adjusted
standardized estimates Age, sex, race, education,
income, social network,
heart disease, dyslipi-
demia, diabetes, nonlife
threatening cancer,
kidney failure, number
of adults and children in
childhood home, prena-
tal education, systolic BP,
systemic inflammation,
depression symptoms,
perceived stress, BMI
Zahodne et al., 2021 [102] 578 663.5% ≥ 65 years Community- dwelling WHICAP neuropsycho-
logical battery (episodic
memory, language,
visuospatial function-
ing); NIH Toolbox
cognition module
(executive function,
working memory)
Longitudinal models Age, sex, race, education,
depression, presence /
absence of 15 chronic
conditions, baseline
cognition
AMT Abbreviated Mental Test, BNT Boston Naming Test, BOMC Blessed Memory Orientation Concentration Test, BVMT-R Brief Visuospatial Memory Test – Revised, CERAD Consortiumto Establish a Registry for Alzheimer’s
Disease, DRS Dementia Rating Scale, DSST Digit Symbol Substitution Test, DWRT Delayed Word Recall Test, EBMT East Boston Memory Test, ECAQ Cognitive Assessment Questionnaire, GMS Geriatric Mental State,
MANCOVA Multivariate analysis of Covariance, MDRS Mattis Dementia Rating Scale, MHT Moray House Test, MMSE Mini Mental State Examination, MoCA Montreal Cognitive, RAVLT Rey Auditory Verbal Learning Test, RBANS
Repeatable Batteryfor the Assessment of Neuropsychological Status, SCI Subjective Cognitive Impairment, SCOPA-COG Scales for Outcomes in Parkinson’s Disease – Cognition, SDMT Symbol Digit Modalities Test, SIDAM
Structured Interview for the Diagnosis of Dementia of the Alzheimer type, Multi-infarct Dementia and Dementia of other Aetiology, SPMSQ Short Portable Mental Status Questionnaire, TMT Trail Making Test A & B, VMS
Verbal Memory Score, WAIS Wechsler Adult Intelligence Test, WFT Word Fluency Test, WMS Wechsler Memory Scale
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Mogicetal. Systematic Reviews (2023) 12:86
Table 2 Overall risk of bias ratings
Author, Year Rating Author, Year Rating
Cross-Sectional Studies
Alpass et al., 2004 [27] Medium Millán-Calenti et al., 2013 [47]Low
Bourgeois et al., 2020 [23] Medium Murayama et al., 2019 [48]Low
Bourne et al., 2007 [28] Medium Nakamura et al., 2019 [49]Low
Conroy et al., 2010 [29] Medium Okabayashi et al., 2004 [50]Low
Deng & Liu, 2021 [30] Medium Oremus et al., 2019 [6]Low
Ficker et al., 2002 [24] Medium Oremus et al., 2020 [7]Low
Frith & Loprinzi, 2017 [31]Low Pillemer & Holtzer, 2016 [51]Low
Ge et al., 2017 [32]Low Poey et al., 2017 [52] Medium
Gow et al., 2007 [33]Low Rashid et al., 2016 [53]Low
Gow et al., 2013 [34]Low Saenz et al., 2020 [54]Low
Hamalainen et al., 2019 [35]Low Sims et al., 2014 [55] Medium
Harling et al., 2020 [36] Medium Weng et al., 2020 [56] Medium
Henderson et al., 1986 [37] Medium Yang et al., 2020 [57]Low
Holtzman et al., 2004 [38]Low Yeh & Liu, 2003 [58]Low
Jang et al., 2020 [39]Low Zahodne et al., 2014 [59]Low
Keller-Cohen et al., 2006 [40] Medium Zahodne et al., 2018 [60]Low
Kim et al., 2019 [41]Low Zank & Leipold, 2001 [61]Low
Kotwal et al., 2016 [42]Low Zhaoyang et al., 2021 [62]Low
Krueger et al., 2009 [43] Medium Zhu et al., 2012 [63] Medium
La Fleur & Salthouse, 2017 [44]Low Zuelsdorff et al., 2013 [64]Low
Lee & Waite, 2018 [45]Low Zuelsdorff et al., 2019 [65]Low
Mehrabi & Béland, 2021 [46]Low Zullo et al., 2021 [66] Medium
Author, Year Rating Author, Year Rating
Cohort Studies
Amieva et al., 2010 [67]Low Liu et al., 2020 [85]Low
Andel et al., 2012 [68]Low Luo et al., 2021 [86]Low
Bedard & Taler, 2020 [69] Medium Miyaguni et al., 2021 [87] High
Bowling et al., 2016 [70]Low Moreno et al., 2022 [88] Medium
Camozzato et al., 2015 [71]Low Murata et al., 2019 [16]Low
Chen & Chang, 2016 [72] Medium Noguchi et al., 2019 [89]Low
Chen & Zhou, 2020 [73]Low Okely et al., 2021 [90] Medium
Crooks et al., 2008 [25]Low Pais et al., 2021 [91]Low
Dickinson et al., 2011 [74] Medium Pillemer et al., 2019 [17]Low
Eisele et al., 2012 [75]Low Riddle et al., 2015 [92] Medium
Ellwardt et al., 2013 [76]Low Rote et al., 2021 [93] Medium
Heser et al., 2014 [77]Low Saito et al., 2018 [94]Low
Holtzman et al., 2004 [38]Low Salinas et al., 2017 [95]Low
Howrey et al., 2015 [78] Medium Seeman et al., 2001 [96]Low
Hudetz et al., 2010 [26] Medium Sörman et al., 2015 [97]Low
Hughes et al., 2008 [79]Low Thomas & Umberson, 2018 [98] Medium
Kats et al., 2016 [80]Low Wilson et al., 2015 [99]Low
Khondoker et al., 2017 [81]Low Yin et al., 2020 [100]Low
Khoo & Yang, 2020 [82] Medium Zahodne et al., 2019 [101]Low
Liao & Scholes, 2017 [84]Low Zahodne et al., 2021 [102]Low
Liao et al., 2018 [83] Medium
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Mogicetal. Systematic Reviews (2023) 12:86
chronic conditions such as diabetes, cardiovascular dis-
ease, and hypertension. Most articles had low risk of bias
(Table2; Fig.2). Overall, functional social support was
protective against cognitive outcomes (Fig.3).
Narrative synthesis
Alzheimer’s disease orall‑cause dementia
Cross‑sectional studies Four of the five cross-sectional
studies reported on dementia, while the remaining study
reported results for AD and non-AD dementia (Table3).
Four studies focused on functional social support, two of
which reported no association with dementia. One found
greater functional social support to be significantly asso-
ciated with lower severity of dementia. One reported this
support as being a moderate protective factor against
AD, but a small risk factor for non-AD dementia. One
study found that all-cause dementia was associated with
lower satisfaction with diffuse social relationships, but
not with close social relationships [29, 37, 42, 52, 57].
Cohort studies Nine of 14 cohort studies reported an
outcome of all-cause dementia, four studies reported
outcomes of AD and non-AD dementia independently,
and one study reported an outcome of only AD (Table3).
Eight studies explored the effects of emotional social
support, six of which found small to moderate protec-
tive effects against dementia (one reached statistical sig-
nificance). One observed a small protective effect in both
male and female strata. Two studies reported small posi-
tive, but not statistically significant, associations between
emotional support and all-cause dementia. Two of the
eight studies found moderate protective effects for emo-
tional social support against AD [16, 25, 71, 77, 81, 85, 87,
92–95].
Four studies assessed instrumental social support, one
of which reported a large positive association with both
AD and non-AD dementia (statistically significant in the
case of AD). Another study found small protective effects
against dementia in both male and female participants.
One study found that individuals identified as having
increasing dementia were more likely to fall within the
low instrumental support group. One study found no
association [16, 77, 92, 93].
Two studies found satisfaction with social support to
have moderate protective effects against dementia, with
one being statistically significant. One of these also
found satisfaction to have a moderate and nonsignificant
protective effect against AD [25, 67]. Khondoker etal.
reported positive social support had small protective
effects against dementia [81]. Andel etal. showed work-
place social support was protective against AD and non-
AD dementia (statistically significant for non-AD) [68].
Global cognitive functioning
Cross‑sectional studies ree cross-sectional studies
examined participant satisfaction with functional social
support and global cognitive function (Table 4). Two
reported positive yet statistically non-significant associa-
tions, and one found no association [27, 34, 40].
Twelve cross-sectional studies explored the associa-
tion between perceived or subjective functional social
support and global cognitive function, with 11 report-
ing positive associations (10 statistically significant),
and one reporting a negative association (Table4). One
study observed significant positive effects among females
only. One reported that support from a wife was posi-
tively associated with a husband’s cognitive function, but
not vice versa. One observed a positive association for
spouse-provided support, but not support from children,
friends, and extended family. One found links between
greater subjective cognitive decline and greater levels of
perceived social support [6, 23, 24, 29, 43, 45, 46, 54, 58,
61, 63, 66].
Eight studies assessed the association between emotional
social support and global cognitive function; authors
Fig. 2 Risk of Bias
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Page 17 of 31
Mogicetal. Systematic Reviews (2023) 12:86
reported positive associations in all eight, with seven
reaching statistical significance. Six studies explored the
effect of instrumental social support on cognitive func-
tion and two found statistically significant positive asso-
ciations, one found a non-significant positive association,
one found no association, one reported a small (non-
significant) negative association, and one found positive
associations in male (significant) and female (non-signif-
icant) strata. ree studies assessed the combined effects
of emotional and instrumental social support on global
cognitive function and found significant positive associa-
tions [30, 32, 33, 36, 38, 41, 47–51, 56].
Rashid et al. assessed general functional social support
and observed that individuals with lower reported levels
of support were at an increased risk of cognitive impair-
ment [53]. Jang etal. used family solidarity as a measure
of functional social support and found no association
between this variable and cognitive function [39].
Cohort studies One study found a positive association
between functional social support and global cogni-
tive function. Nine other studies assessed the associa-
tion between perceived / subjective social support and
global cognitive function, with six reporting positive
Fig. 3 Count of Reported Associations between Functional Social Support and Cognition-related Outcomes in the Narrative Synthesis
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Mogicetal. Systematic Reviews (2023) 12:86
Table 3 Studies reporting outcome of Alzheimer’s Disease or dementia
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Study Design: Cross-Sectional
Conroy et al., 2010 [29] Perceived / Subjective Dementia: OR = 1.0 (p = 0.934) Perceived social support not associated with
dementia
Kotwal et al., 2016 [42] Perceived / Subjective Dementia: 0.00 (-0.45, 0.46) Perceived social support not associated with
dementia
Poey et al., 2017 [52] Perceived / Subjective AD: RR = 0.567 (p = 0.174)
Dementia: RR = 1.135 (p = 0.701) Perceived social support has a protective effect
against AD. Perceived support is associated with a
small increased risk of non-AD dementia
Yang et al., 2020 [57] Perceived / Subjective Severity of dementia: x2 = 64.70 (p < 0.001) Greater perceived social support significantly
associated with lower severity of dementia
Henderson et al., 1986 [37] Satisfaction with FSS Dementia: 0.06 (p = 0.002) Participants with dementia reported significantly
lower satisfaction with diffuse social relationships
than non-demented participants (value for satis-
faction with close relationships not reported)
Study Design: Cohort
Andel et al., 2012 [68] Social Support at Work AD: OR = 0.88 (0.76, 1.0) **
Dementia: OR = 0.87 (0.78, 0.97) ** Greater overall social support at work has protec-
tive effect against AD and dementia. Significant in
case of dementia
Amieva et al., 2010 [67] Satisfaction with FSS AD: RR = 0.84 (0.3, 1.3)
Dementia: RR = 0.77 (0.6, 0.9) Satisfaction with social support has protective
effect against dementia and AD; significant pro-
tective effect in case of dementia
Crooks et al., 2008 [25] Satisfaction with FSS Dementia: HR = 0.74 (0.78, 1.23) Satisfaction with social support reduces risk of
dementia
Camozzato et al., 2015 [71] Perceived / Subjective AD: HR = 0.19 (0.07, 0.52)bPerceived support based on presence of confi-
dants associated with significantly decreased risk
of developing AD
Riddle et al., 2015 [92] Perceived / Subjective Dementia: x2 = 0.29 (p = 0.59) Perceived support did not predict conversion to
dementia
Heser et al., 2014 [77] Emotional AD: HR = 0.54 (0.19, 1.55)
Dementia: HR = 1.02 (0.39, 2.66) Small positive association between emotional
support and all-cause dementia. Emotional sup-
port has protective effect against AD
Liu et al., 2020 [85] Emotional Dementia: HR = 1.10 (0.88, 1.37) Receiving emotional social support associated
with small (non-significant) increased risk of
dementia
Miyaguni et al., 2021 [87] Emotional Dementia: 0.97 (0.94, 0.99) Receiving emotional support significantly associ-
ated with decreased risk of dementia
Murata et al., 2019 [16] Emotional Dementia – Males: HR = 0.95 (0.39, 2.66) a
Dementia – Females: HR = 0.98 (0.82, 1.18) aEmotional support has small protective effect
against dementia in both males and females
Rote et al., 2021 [93] Emotional Low Support
Likely dementia: 40.6%
Increasing dementia: 49.1%
No impairment: 10.3%
High Support
Likely dementia: 43.6%
Increasing dementia: 36.9%
No dementia: 19.5%
Values reported are conditional probabilities.
Higher conditional probability of increasing
dementia risk group belonging to low emotional
support group
Saito et al., 2018 [94] Emotional Dementia: HR = 0.96 (0.89, 1.04) aEmotional support from family has small protec-
tive effect against dementia; effect even smaller
in case of emotional support from friends. Small
positive association between emotional support
from relatives and dementia
Salinas et al., 2017 [95] Emotional Dementia: HR = 0.78 (0.56, 1.09) Emotional support has protective effect against
dementia
Sörman et al., 2015 [97] Emotional Dementia: HR = 0.82 (0.60, 1.11)
AD: HR = 0.72 (0.48, 1.07) Emotional support has protective effect against
dementia and AD
Heser et al., 2014 [77] Instrumental Dementia: HR = 2.34 (0.91, 6.02)
AD: HR = 3.57 (1.12, 11) Large positive association between instrumental
support and dementia and AD; association is
significant in case of AD
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Mogicetal. Systematic Reviews (2023) 12:86
associations, four of which were significant. One reported
a negative association for Black people and a positive
association for White people, although neither was sig-
nificant. One showed a negative association for support
from the family and a positive association for support
from friends, with neither being statistically significant.
One found perceived social support to be significant
positively associated with cognitive function in persons
whose cognition test scores were rapidly declining but
found no association when scores were slowly declining
or stable [26, 70, 73, 75, 78–80, 86, 88, 91].
Nine other cohort studies assessed the impact of emo-
tional social support on global cognitive function. ree
reported positive associations, one of which was signifi-
cant. Two studies reported negative associations, nei-
ther of which was significant. In one study, emotional
social support received from participants’ children was
inversely associated with cognitive function. Similarly,
inverse associations were found in male and female
strata, though neither was statistically significant. One
study identified significant protective effects for emo-
tional support in persons whose baseline cognition was
low and declining over time, and non-significant protec-
tive effects in those with high and declining cognition,
compared to individuals with high and stable cognition
[17, 38, 69, 72, 76, 79, 89, 96, 98].
Eight cohort studies explored instrumental social sup-
port and global cognitive function. Six studies reported
positive associations, one of which was statistically signif-
icant. ree found non-significant negative associations.
One study assessed the combined effects of emotional
and instrumental social support, stratified by the source
of support (co-residing family, non-residing family and
relatives, neighbours and friends), and reported signifi-
cant positive associations in the neighbours and friends
stratum; the associations in the other two strata were
inverse and non-significant [17, 69, 74, 76, 79, 89, 96,
100].
Studies reporting outcomes bycognitive domain
Twenty-seven studies examined the effects of functional
social support on one or more specific cognitive domains
(Table5). Most studies assessed multiple domains, with
17 studies examining memory, 13 executive function, 3
attention and processing speed, 4 language ability, and 3
mild cognitive impairment (MCI).
Memory Cross‑Sectional Studies. Ten cross-sectional
studies explored the association between functional
social support and memory. One found a positive, non-
significant association for satisfaction with available sup-
port. Two of five studies reported positive and statisti-
cally significant associations between perceived social
support and memory. Two reported positive associations
between perceived support and verbal memory, with the
only statistically significant association involving memory
measured longitudinally. ey also found negative and
non-significant associations between perceived support
and working memory at both time periods, and a positive
and significant association between perceived support
and visual memory measured longitudinally. One found
a significant association between lower perceived social
Table 3 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Murata et al., 2019 [16] Instrumental Dementia: Female: 0.98a (0.88, 1.09)
Dementia: Male: 0.95a (0.83, 1.08) Instrumental support has a small protective effect
against dementia in both males and females
Riddle et al., 2015 [92] Instrumental Dementia: x2 = 1.99 (p = 0.16) Instrumental support did not predict conversion
to dementia
Rote et al., 2021 [93] Instrumental Low Support
Likely dementia: 40.0%
Increasing dementia: 48.4%
No impairment: 11.6%
High Support
Likely dementia: 43.7%
Increasing dementia: 36.8%
No dementia: 19.5%
Values reported are conditional probabilities.
Higher conditional probability of increasing
dementia risk group belonging to low instrumen-
tal support group
Khondoker et al., 2017 [81] Positive social support Dementia: HR = 0.87 (0.72, 1.06) Positive social support has a small protective
effect against dementia
AD Alzheimer’s Disease, CI Condence Interval, FSS Functional Social Support, HR Hazard Ratio, OR Odds Ratio, RR Relative Risk
a Eects merged using Borenstein: Murata etal. (2019) and Saito etal. (2018) both reported specic sources of functional social support (co-residing family, relatives,
or friends), which were merged using Borenstein’s equation for reporting in the data tables (Borenstein etal., 2009)
** Inverse of point estimate and condence limits taken to convert outcome to yes versus no
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Table 4 Studies reporting outcome of global cognitive functioning
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Study Design: Cross-Sectional
Alpass et al., 2004 [27] Satisfaction with FSS 0.034 (p-value not reported) Satisfaction with social support is positively but not signifi-
cantly associated with cognitive function
Gow et al., 2013) [34] Satisfaction with FSS positive direction of association (p = 0.278) Satisfaction with social support is positively but not signifi-
cantly associated with cognitive function
Keller-Cohen et al., 2006 [40] Satisfaction with FSS Quantitative data for this variable not reported Satisfaction with social relationships did not predict perfor-
mance on Composite Cognistat or BNT
Bourgeois et al., 2020 [23] Perceived / Subjective 1.72 (p = sig) Perceived social support significantly positively associated
with better outcome on MoCA
Conroy et al., 2010 [29] Perceived / Subjective OR = 1.3 (p = 0.175) Low perceived social support (+ widowed and lives alone)
positively associated with possible cognitive impairment
Ficker et al., 2002 [24] Perceived / Subjective 3.589 (p < 0.001) Cognitively impaired elders perceived their social support
as significantly less adequate than did the cognitively intact
participants
Krueger et al., 2009 [43] Perceived / Subjective 0.068 (p = 0.003)aSmall significant positive association between perceived sup-
port and global cognitive function
Lee & Waite, 2018 [45] Perceived / Subjective Female—0.65 (p < 0.05)
Male – no association Significant positive effect of social support on cognition only
in female participants. No association in male participants
Mehrabi & Béland, 2021 [46] Perceived / Subjective Partner—0.275 (0.028, 0.522)
Children – no association
Friends – no association
Extended family – no association
Low perceived social support from partner significantly
positively associated cognitive impairment. No associa-
tion between perceived support from children, friends, or
extended family and cognitive function
Oremus et al., 2019 [6] Perceived / Subjective Proportion of participants with low cognitive function greater
among persons who reported low perceived social support
(and vice versa)
Saenz et al., 2020 [54] Perceived / Subjective (from spouse) Husbands: 0.02 (0.01,0.03)
Wives: 0.00 (-0.01, 0.01) Perceived social support from wife significantly positively
associated with the husband’s cognitive ability
Yeh & Liu, 2003 [58] Perceived / Subjective (from friends) 0.11 (p = 0.005) Perceived positive support from friends is significantly and
positively associated with cognitive function
Zank & Leipold, 2001 [61] Perceived / Subjective R2 = 0.085 (p < 0.05) Perceived social support positively and significantly associated
with cognitive function
Zhu et al., 2012 [63] Perceived / Subjective 0.020 (p < 0.05) Total perceived support positively and significantly associated
with cognitive function
Zullo et al., 2021 [66] Perceived / Subjective OR = 0.93 (0.70, 1.24) Individuals with subjective cognitive decline scored higher on
the MSPSS indicating greater perceived social support
Deng & Liu, 2021 [30] Emotional Relatives/friends/neighbors: OR = 0.219 (0.154, 0.311)
Children: OR = 0.400 (0.293, 0.546)
Spouse: OR = 0.242 (0.160, 0.366)
Emotional support from relatives / friends / neighbors, chil-
dren, or spouse significantly associated with a reduced risk of
cognitive impairment
Harling et al., 2020 [36] Emotional 0.72 (0.63, 0.82) Emotional support significantly associated with decreased risk
of cognitive impairment
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Mogicetal. Systematic Reviews (2023) 12:86
Table 4 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Kim et al., 2019 [41] Emotional 4.160 (p = 0.002) Emotional support significantly positively associated with
cognitive function
Murayama et al., 2019 [48] Emotional Male: OR = 0.46 (0.24, 0.86) **
Female: OR = 0.59 (0.35, 0.99) ** Higher emotional support significantly associated with
decreased risk of cognitive impairment
Nakamura et al., 2019 [49] Emotional -0.02 (p = 0.04) Higher emotional social support significantly associated with
better cognitive scores
Okabayashi et al., 2004 [50] Emotional Spouse: 0.02 (p < 0.05)
Children: 0.05 (p < 0.05)
Others: 0.01 (p < 0.05)
Emotional support from spouse, children, or others all signifi-
cantly positively associated with cognitive function
Pillemer & Holtzer, 2016 [51] Emotional 1.620 (0.343, 2.897) Emotional support positively associated with cognitive func-
tion
Weng et al., 2020 [56] Emotional OR = 1.68 (1.37 to 2.06) Insufficient emotional support significantly associated with
increased reporting of subjective cognitive decline
Deng & Liu, 2021 [30] Instrumental OR = 0.242 (0.630, 0.804) Instrumental (financial) support significantly associated with
decreased risk of cognitive impairment
Harling et al., 2020 [36] Instrumental 0.73 (0.64, 0.82) Instrumental support significantly associated with decreased
risk of cognitive impairment
Millán-Calenti et al., 2013 [47] Instrumental OR = 1.04 (0.27, 4.0) bSmall positive association between instrumental support and
cognitive function
Murayama et al., 2019 [48] Instrumental Male: OR = 0.43 (0.22, 0.83) b
Female: OR = 0.62 (0.30, 1.28) bHigher instrumental support associated with decreased risk of
cognitive impairment. Significant association in males
Nakamura et al., 2019 [49] Instrumental 0.00 (p = 0.97) No association between instrumental support and cognitive
function
Pillemer & Holtzer, 2016 [51] Instrumental -0.235 (-1.535, 1.066) Tangible support has a small negative association with cogni-
tive function
Ge et al., 2017 [32] Emotional + Instrumental R2 = 0.11 (p < 0.001) Emotional and instrumental support significantly positively
associated with cognitive function
Gow et al., 2007 [33] Emotional + Instrumental 0.14 (p < 0.01) Emotional and instrumental support significantly positively
associated with IQ
Holtzman et al., 2004 [38] Emotional + Instrumental 0.25 (p < 0.0005) Emotional and instrumental support significantly positively
associated with cognitive function
Pillemer & Holtzer. 2016 [51] Positive Interaction B = 1.8883 (0.595, 3.171) Positive social interaction positively associated with cognitive
function
Pillemer & Holtzer, 2016 [51] Affectionate B = -0.093 (-1.369, 1.183) Affectionate social interaction not associated with cognitive
function
Rashid et al., 2016 [53] FSS OR = 2.6 (1.2–5.4) Increased risk of cognitive impairment among individuals with
poor social support
Jang et al., 2020 [39] Family Solidarity 0.00 No association between family solidarity and cognitive func-
tion
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Table 4 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Study Design: Cohort
Hughes et al., 2008 [79] Satisfaction with FSS 0.09 (p = 0.22) Positive association between satisfaction with social support
and cognitive function
Bowling et al., 2016 [70] Perceived / Subjective Family: -0.01 (-0.30, 0.27)
Friend: 0.02 (-0.29, 0.32) Small negative association between perceived support from
family and cognitive function. Small positive association
between perceived support from friends and cognitive func-
tion
Chen & Zhou, 2020 [73] Perceived / Subjective OR = 2.09 (p < 0.001) Social isolation significantly associated with cognitive impair-
ment
Eisele et al., 2012 [75] Perceived / Subjective F-ratio = 2.114 Positive association between perceived support and cognitive
function
Howrey et al., 2015 [78] Perceived / Subjective Rapid decline: 1.89 (p < 0.001)
Slow decline: 0.25
Stable: 0.35
In rapid decline group, social support significantly associated
with increases in MMSE
Hudetz et al., 2010 [26] Perceived / Subjective 0.01 (p = 0.64) Small positive association between perceived support and
cognitive function
Kats et al., 2016 [80] Perceived / Subjective African Americans: -0.01 (-0.14, 0.12); Caucasians: 0.01 (-0.05,
0.05) Small negative association between perceived support and
cognitive function in African American population. Small
positive association between perceived support and cognitive
function in Caucasian population
Luo et al., 2021 [86] Perceived / Subjective b = 1.90 (p = 0.050) Quality of social relationships significantly predicts cognitive
function
Moreno et al., 2022 [88] Perceived / Subjective 0.066 (p < 0.001) Significant positive association between perceived social sup-
port and cognitive function
Pais et al., 2021 [91] Perceived / Subjective (from friends) HR = 0.77 (0.635, 0.933) Perceived social support from friends significantly associated
with a reduced risk of cognitive impairment
Bedard & Taler, 2020 [69] Emotional OR = 0.97 (0.95, 0.99) Emotional support had a small but significant protective effect
against cognitive decline
Chen & Chang, 2016 [72] Emotional Starting high and declining: 0.87 (0.71, 1.07)
Starting low and declining: 0.77 (0.60, 0.99) Emotional social support had a significant protective effect in
the starting low and declining group compared with the high-
stable group. (Protective but not statistically significant effect
in starting high and declining group)
Ellwardt et al., 2013 [76] Emotional 0.03 (intercept), 0.40 (slope), p = 0.06 Emotional support positively associated with cognitive func-
tion
Holtzman (2004) [38] Emotional Continuous model: 0.15 (p < 0.005)
Categorical model: 0.18 (p < 0.004) Emotional support was a significant predictor of MMSE scores
Hughes et al., 2008 [79] Emotional -0.05 (p = 0.45) Small negative association between emotional support and
cognitive function
Noguchi et al., 2019 [89] Emotional -0.42 (p = 0.462) Emotional support negatively associated with cognitive func-
tion
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Table 4 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Pillemer et al., 2019 [17] Emotional Incident cognitive decline: HR = 1.43 (0.94,2.18)
Cognitive decline – males: HR = 1.62 (0.93,2.84)
Cognitive decline – females: HR = 1.39 (0.68,2.84)
Emotional support positively associated with cognitive decline
Seeman et al., 2001 [96] Emotional 1.26 (p = 0.07) Emotional support positively associated with cognitive func-
tion
Thomas & Umberson, 2018 [98] Emotional (from children) -0.004, p < 0.05 Support from children related to fewer cognitive limitations
Bedard & Taler, 2020 [69] Instrumental OR = 0.98 (0.94, 1.02) Instrumental support had a small protective effect against
cognitive decline
Dickinson et al., 2011 [74] Instrumental 0.578 (p = 0.0333) Instrumental support significantly positively associated with
cognitive function
Ellwardt et al., 2013 [76] Instrumental -0.01 (intercept), -0.02 (slope) Small negative association between instrumental support and
cognitive function
Hughes et al., 2008 [79] Instrumental 0.01 (p = 0.88) Small positive association between instrumental support and
cognitive function
Noguchi et al., 2019 [89] Instrumental 0.38 (p = 0.642) Instrumental support positively associated with cognitive
function
Pillemer et al., 2019 [17] Instrumental Incident cognitive decline: HR = 1.75 (1.12,2.72)
Cognitive decline – males: HR = 1.91 (1.00,3.62)
Cognitive decline – females: HR = 1.78 (0.94,3.35)
Instrumental support positively associated with cognitive
decline
Seeman et al., 2001 [96] Instrumental -0.04 (p = 0.93) Small negative association between instrumental support and
cognitive function
Yin et al., 2020 [100] Instrumental (sick care) HR = 0.795 (0.550, 1.148) Instrumental support negatively associated with cognitive
impairment
Noguchi et al., 2019 [89] Emotional + Instrumental Co-residing family: 0.28, p = 0.813
Non-residing family and relatives: 0.51 (p = 0.283)
Neighbours and friends: 1.23, p = 0.006
Significant positive association between emotional and
instrumental social support from neighbours and friends and
MoCA-J scores. Negative association between emotional and
instrumental support from co-residing family or non-residing
family and relatives and cognitive function
CI Condence Interval, FSS Functional Social Support, HR Hazard Ratio, MoCA-J Japanese version of the Montreal Cognitive Assessment, OR Odds Ratio, RR Relative Risk
a Eects merged using Borenstein (Borenstein etal., 2009)
b Inverse of point estimate and condence limits taken to convert outcome to yes vs. no or high vs. low
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Table 5 Studies Reporting other cognitive outcomes
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Study Design: Cross-Sectional, Outcome: Executive Function
Gow et al., 2013 [34] Satisfaction with FSS positive direction of association; p = 0.075 Satisfaction with social support is positively
but not significantly associated with execu-
tive function
Bourne et al., 2007) [28] Emotional -0.14 (p < 0.05) Emotional support significantly negatively
associated with executive function
Frith & Loprinzi, 2017 [31] Emotional Any support: B = 6.4 (2.9, 10) Emotional functional social support signifi-
cantly positively associated with executive
function (of individual support types, only
spousal support significantly associated
with cognition)
La Fleur & Salthouse, 2017 [44] Emotional 0.10 (p < 0.001) Emotional support significantly positively
associated with executive function
Zahodne et al., 2014 [59] Emotional 0.17 (0.06)
0.09 (0.06) Emotional support positively associated
with executive function
Bourne et al., 2007 [28] Instrumental -0.13 (p < 0.05) Satisfaction with instrumental support
negatively associated with executive func-
tion
La Fleur & Salthouse, 2017 [44] Instrumental 0.02 (p > 0.01) Small positive association between instru-
mental support and executive function
Zahodne et al., 2014 [59] Instrumental DCCS: -0.04 (0.05)
Flanker: 0.00 (0.05) Instrumental support not associated with
executive function
Ge et al., 2017 [32] Emotional + Instrumental R^2 = 1.44 (p < 0.001) Emotional and instrumental support signifi-
cantly positively associated with executive
function
Hamalainen et al., 2019 [35] Perceived / Subjective B = 0.002 (p = 0.001) Small positive association between per-
ceived support and executive function
Krueger et al., 2009 [43] Perceived / Subjective 0.089 (p = 0.036) aPerceived support significantly positively
associated with executive function
Study Design: Cohort, Outcome: Executive Function
Dickinson et al., 2011 [74] Instrumental 0.284 (p = 0.0064)
0.578 (p = 0.0333) Instrumental support significantly positively
associated with executive function
Liao & Scholes, 2017 [84] Positive social support 0.017 (0.009, 0.026) Positive social support significantly posi-
tively associated with executive function
Liao et al., 2018 [83] Confiding support Y = − 0.05 (− 0.17, 0.07) No association between confiding support
and executive function
Hudetz et al., 2010 [26] Perceived / Subjective z-score = -0.01, p = 0.33 Perceived social support does not signifi-
cantly predict post-operative executive
functioning
Zahodne et al., 2021 [102] Emotional 0.11 (not significant) Emotional social support positively associ-
ated with executive function
Zahodne et al., 2021[102] Instrumental -0.03 (not significant) Instrumental social support negatively asso-
ciated with executive function
Study Design: Cross-Sectional, Outcome: Memory
Gow et al., 2013 [34] Satisfaction with FSS positive direction of association
(p = 0.275) Satisfaction with social support is positively
but not significantly associated with
memory
Ge et al., 2017 [32] Emotional + Instrumental Working: R2 = 0.18 (p < 0.05)
Episodic: R2 = 0.11 (p < 0.001) Emotional and instrumental support
significantly positively associated with both
episodic and working memory
Hamalainen et al., 2019 [35] Perceived / Subjective B = 0.002 (p < 0.001) Small positive and significant association
between perceived support and memory
Krueger et al., 2009 [43] Perceived / Subjective Episodic: 0.023 (p = 0.444)
Semantic: 0.055 (p = 0.056)
Working: 1.07 (p = 0.003)
Small positive association between per-
ceived support and episodic and semantic
memory. Much larger and statistically
significant positive association between
perceived support and working memory
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Table 5 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Okely et al., 2021 [90] Perceived / Subjective - 0.169 (p < 0.05) Lower perceived social support signifi-
cantly associated with increased memory
problems
Zuelsdorff et al., 2013 [64] Perceived / Subjective Immediate: 0.006 (not significant)
Verbal:0.037 (not significant)
Working: -0.024 (not significant)
Small positive association between
perceived support and immediate and
verbal memory. Small negative association
between perceived support and working
memory
Zuelsdorff et al., 2019 [65] Perceived / Subjective Immediate: 0.07 (p = 0.01)
Verbal: 0.04 (not significant)
Working: 0.04 (not significant)
Visual: 0.09 (p < 0.001)
Perceived support significantly positively
associated with immediate and visual
memory. Perceived support positively asso-
ciated with verbal and working memory
Kim et al., 2019 [41] Emotional 1.696 (p = 0.003) Higher emotional support significantly
associated with better verbal memory
La Fleur & Salthouse, 2017 [44] Emotional 0.11 (p < 0.001) Emotional support significantly positively
associated with memory
Oremus et al., 2020 [7] Emotional Immediate: B = 0.06 (0.03, 0.09)
Delayed: B = 0.05 (0.02, 0.08) Emotional support significantly positively
associated with both immediate and
delayed memory
Zahodne et al., 2014 [59] Emotional Working: 0.09
Episodic: 0.09 Emotional support positively associated
with both working and episodic memory
La Fleur & Salthouse, 2017 [44] Instrumental -0.01 (p > 0.01) No association or small negative associa-
tion between instrumental support and
memory
Sims et al., 2014 [55] Instrumental -0.17 (p < 0.05) Significant negative association between
instrumental support and nonverbal recall
Zahodne et al., 2014 [59] Instrumental Working: 0.01
Episodic: -0.01 Small positive association between instru-
mental support and both working memory.
Small negative association between instru-
mental suport and episodic memory
Oremus et al., 2020 [7] Positive Immediate: B = 0.05 (0.02, 0.07)
Delayed: B = 0.04 (0.01, 0.07) Positive support significantly positively
associated with both immediate and
delayed recall
Oremus et al., 2020 [7] Affectionate Immediate: B = 0.05 (0.02, 0.08)
Delayed: B = 0.05 (0.02, 0.07) Affectionate support significantly positively
associated with both immediate and
delayed recall
Study Design: Cohort, Outcome: Memory
Hudetz et al., 2010 [26] Perceived / Subjective z-score = -0.02, p = 0.40 Perceived social support does not sig-
nificantly predict post-operative verbal
memory
Zahodne et al., 2018 [60] Perceived / Subjective Working: R^2 = 0.18 (p < 0.05)
Episodic: R^2 = 0.11 (p < 0.001) Significant positive association between
perceived social support and both working
and episodic memory
Hughes et al., 2008 [79] Emotional -0.02 (p = 0.83) Small negative association between emo-
tional support and memory
Zahodne et al., 2021 [102] Emotional Working: 0.04 (not significant)
Episodic: -0.11 (not significant) Small positive association between
emotional support and working memory.
Negative association between emotional
support and episodic memory
Hughes et al., 2008 [79] Instrumental 0.01 (p = 0.93) Small positive association between instru-
mental support and memory
Zahodne et al., 2021 [102] Instrumental Working: -0.03 (not significant)
Episodic: 0.00 (not significant) Small negative association between instru-
mental support and working memory. No
association between instrumental support
and episodic memory
Hughes et al., 2008 [79] Satisfaction with FSS 0.18 (p = 0.06) Satisfaction with social support positively
associated with memory
Liao & Scholes, 2017 [84] Positive social support 0.018 (0.003, 0.033) Positive social support significantly posi-
tively associated with memory
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Mogicetal. Systematic Reviews (2023) 12:86
support and greater problems with memory or forgetful-
ness [34, 35, 43, 64, 65, 90].
Four studies examining emotional social support and
memory reported positive associations, with results
in three achieving statistical significance. One found
the association between emotional support and verbal
memory to be mediated by hippocampal volume, one
reported similar strengths of association for immediate
and delayed recall memory, and one found positive asso-
ciations of the same magnitude for working and episodic
memory [7, 41, 44, 59].
ree studies assessed the effects of instrumental social
support on memory: one reported a statistically signifi-
cant negative association with general memory [55]; one
Table 5 (continued)
Author (year) Dimension of FSS Coecient (CI or P-value) Interpretation
Study Design: Cross-Sectional, Outcome: Language
La Fleur & Salthouse, 2017 [44] Emotional 0.13 (p < 0.001) Emotional support significantly positively
associated with language ability
La Fleur & Salthouse, 2017 [44] Instrumental 0.01 (p > 0.01) No association or small positive associa-
tion between instrumental support and
language ability
Study Design: Cohort, Outcome: Language
Hudetz et al., 2010 [26] Perceived / Subjective z-score = 0.01 (p = 0.69) Perceived social support does not signifi-
cantly predict verbal memory
Zahodne et al., 2018 [60] Perceived / subjective Initial cognitive level: 0.022 (-0.010, 0.054)
Annual rate of cognitive change: 0.029
(-0.035, 0.092)
Reported childhood social support posi-
tively but not significantly associated with
initial verbal fluency and rate of decline in
verbal fluency
Zahodne et al., 2021 [102] Emotional -0.05 (not significant) Negative association between emotional
support and language ability
Zahodne et al., 2021 [102] Instrumental -0.07 (not significant) Negative association between instrumental
support and language ability
Study Design: Cross-Sectional, Outcome: MCI
Kotwal et al., 2016 [42] Perceived / Subjective 0.02 (-0.33,0.37) Perceived social support positively associ-
ated with better outcome on MoCA-SA
Poey et al., 2017 [52] Perceived / Subjective RRR = 0.962 (p = 0.259) (reference group
no social support available) Social support has a slightly protective
effect on the onset of MCI
Zhaoyang et al., 2021 [62] General social support -0.13 (-0.34, 0.07) Negative association between general
social support and MCI
Study Design: Cohort, Outcome: MCI
Wilson et al., 2015 [99] Negative social interaction HR = 1.09 (0.81, 1.495)aNegative social interaction positively associ-
ated with MCI
Study Design: Cross-Sectional, Outcome: Attention / Processing Speed
Zuelsdorff et al., 2013 [64] Perceived / Subjective 0.084 (p < 0.05) Perceived social support significantly posi-
tively associated with processing speed
Zuelsdorff et al., 2019 [65] Perceived / Subjective 0.05 (not significant – specific p value not
reported) Perceived social support positively associ-
ated with processing speed
Study Design: Cohort, Outcome: Attention / Processing Speed
Hughes et al., 2008 [79] Emotional 0.07 (p = 0.95) Small positive association between emo-
tional support and attention / processing
speed
Hughes et al., 2008 [79] Instrumental -0.004 (p = 0.99) Instrumental support not associated with
attention / processing speed
Hughes et al., 2008 [79] Satisfaction with FSS 1.24 (p = 0.30) Satisfaction with social support positively
associated with attention / processing
speed
CI Condence Interval, FSS Functional Social Support, HR Hazard Ratio, MCI Minor Neurocognitive Disorder, MoCA-SA Montreal Cognitive Assessment Survey
Adaptation, RR Relative Risk
a Eects merged using Borenstein (Borenstein etal., 2009)
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Mogicetal. Systematic Reviews (2023) 12:86
found a small and non-significant negative association
with overall memory [44]; and one identified a small pos-
itive and non-significant association with working mem-
ory and a small negative and non-significant association
with episodic memory [59]. Finally, Oremus etal. found
positive social interactions and affectionate support to be
independently and positively associated with immediate
and delayed recall memory (statistically significant for
affectionate support) [7].
Cohort Studies. Two studies of perceived support and
memory found either no association [26] or statistically
significant and positive associations with both working
and episodic memory [60]. Liao and Scholes found a pos-
itive and statistically significant association between pos-
itive social support and global memory [84]. Hughes etal.
found a negative association in the case of emotional sup-
port, and positive associations for instrumental support
and satisfaction with social support [79]. Zahodne etal.
found positive and negative associations, respectively,
between emotional and instrumental support, and work-
ing memory; they also observed negative associations
between emotional support and episodic memory, and
no association between instrumental support and epi-
sodic memory [102].
Executive function Cross‑Sectional Studies. Gow etal.
reported a positive and non-statistically significant asso-
ciation between participant satisfaction with functional
social support and executive function, although they did
not provide any numerical findings [34]. Hamalainen
etal. and Krueger etal. reported positive and statistically
significant associations between perceived social support
and executive function [35, 43].
ree of four cross-sectional studies found positive asso-
ciations between emotional social support and executive
function, two of which were statistically significant. One
study stratified by individual sources of emotional sup-
port and only spousal support remained statistically sig-
nificantly associated with executive function. One study
observed a statistically significant negative association
[28, 31, 44, 59].
ree cross-sectional studies assessed the independent
effect of instrumental social support on executive func-
tion: La Fleur and Salthouse found a small yet non-sig-
nificant positive association, Zahodne etal. observed no
association, and Bourne etal. reported a statistically sig-
nificant negative association [28, 44, 59]. Ge etal. evalu-
ated combined emotional and instrumental support on
executive function and reported a statistically significant
positive association [32].
Cohort Studies. Five cohort studies evaluated the effect of
functional social support on executive function. Dickin-
son etal. and Liao & Scholes found positive and statis-
tically significant associations for instrumental and posi-
tive support [74, 84]. Zahodne etal. showed a positive,
but non-significant, association for emotional support
and a negative, non-significant association for instru-
mental support [102]. Liao found no association for con-
fiding support, and Hudetz etal. showed no significant
association between perceived social support and post-
operative executive function [26, 83].
Other cognitive domains (Table5). La Fleur and Salt-
house’s cross-sectional study found a positive association
between instrumental support and language ability, and a
stronger and statistically significant association between
emotional support and language ability [44]. ree
cohort studies reported mixed results of no [26], positive
[60], or negative associations (the latter being non-statis-
tically significant) with language ability [102].
Two cross-sectional studies and one cohort study meas-
ured attention or processing speed. e cross-sectional
studies reported positive associations for perceived social
support [64, 65], with the former reporting a statistically
significant result. e cohort study found no association
for instrumental support, a positive association for emo-
tional support, and a larger positive association with sat-
isfaction with social support [79].
ree cross-sectional studies found slight protective
effects between perceived/overall support and conver-
sion to MCI [42, 52, 62]. One cohort study observed that
negative social interaction was a risk for MCI [99].
Discussion
Overall, functional social support was positively associ-
ated with cognitive function in middle- and older-aged
adults (Fig. 3). However, the results were not uniform
across the 85 included studies.
Overall functional social support
Individual perceptions of functional social support did
not appear to be associated with a diagnosis of AD or
all-cause dementia. Conversely, perceived support was
most often positively associated with improved cogni-
tive function, although these associations did not always
reach statistical significance. Negative associations, or a
lack of association, were sometimes observed in the con-
text of male participants or family members as the only
sources of perceived social support [45, 70]. e negative
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Page 28 of 31
Mogicetal. Systematic Reviews (2023) 12:86
association observed for male participants could suggest
that males and females experience social support differ-
ently and emphasizes distinct aspects of the quality of
social relationships. Social support from family mem-
bers may be inversely associated with cognition because
tumultuous intra-family relations could lead to psychoso-
cial stress.
Emotional social support
Most studies involving a clinical diagnosis of AD or all-
cause dementia reported non-significant negative asso-
ciations between emotional social support and these
outcomes. Most of these studies also found significant
and positive associations with both global and domain-
specific cognitive function. However, negative asso-
ciations or absence of any association were sometimes
observed when considering emotional support provided
by family members [79, 89]. Individuals in need of strong
emotional support from their co-residing family mem-
bers might concomitantly be experiencing some form of
family-based physical or psychological stressors that neg-
atively affect cognition.
Instrumental social support
In contrast to the findings with perceived or emotional
support, an equal number of studies observed positive and
negative associations between instrumental support and
AD or all-cause dementia. Most studies reported non-sig-
nificant positive associations between instrumental sup-
port and domain-specific cognitive outcomes, although
several studies in this group found an inverse association.
For global cognitive function, an approximately equal
number of studies reported positive and negative asso-
ciations. e number of studies with negative associations
was larger in the case of instrumental support compared
to perceived and emotional support. Perhaps these find-
ings merely reflect the increased need for functional sup-
port in day-to-day life among people with dementia, which
can be partially provided by instrumental social support.
Emotional-instrumental social support, satisfaction
withsocial support
Most studies that assessed the combined effects of
emotional and instrumental support reported positive
associations with global and domain-specific cognitive
function. All studies that assessed participant satisfaction
with functional social support found protective effects
against both AD and global dementia. All articles that
measured domain-specific cognitive outcomes found sat-
isfaction with social support to be non-significantly posi-
tively associated with cognition. Reported satisfaction
with social support was also positively associated with
global cognition in most cases.
Positive, aectionate, conding social support
Five studies examined positive, affectionate or confid-
ing types of support [7, 51, 81, 83, 84]. Receiving posi-
tive social support was associated with a decreased risk
of dementia, as well as improved global cognition and
memory. Similarly, affectionate social support was asso-
ciated with decreased risk of dementia and improved
memory. One study explored the effects of confiding sup-
port on executive function and reported no association
between the two variables.
Domain-specic cognitive outcomes
Memory was the most frequently assessed, domain-spe-
cific cognitive outcome. In most cases, functional social
support was positively associated with memory. e
same results were found with executive function. Turn-
ing to the domains of language and attention/processing
speed, all studies reported either no association or a posi-
tive association. Some studies used a clinical diagnosis
of MCI as the cognitive outcome and found functional
social support acted as a protective factor, whereas nega-
tive social interaction served as a risk factor.
Strengths andlimitations
A self-assessment with AMSTAR2 (Additional file 3)
showed the quality of our systematic review was strong
[103]. Our comprehensive search strategy captured many
articles across a spectrum of functional social support
exposures and cognitive outcomes. e nature of the
exposure prevented us from looking at randomized con-
trolled trials. One of the included articles was at high risk
of bias and the narrative synthesis was facilitated by the
similarity of covariate sets in the included articles.
Our review is unique from Kelly etal. [15] and Costa-
Cordella et al. [19] because it focused exclusively on
functional social support. Further, our review contained
the most up-to-date synthesis of the literature on the
topic. e adverse impact of the COVID-19 pandemic on
social engagement, especially among older adults, pro-
vides a renewed impetus to understand how functional
social support affects the cognitive health and well-being
of aging populations.
Conclusions
The findings of this review show that functional social
support may act as a protective factor against dementia
and cognitive decline. This association appears to be
stronger in the case of overall and emotional support,
relative to instrumental support. Policy makers may
wish to allocate public funds for community-based
programs centered on fostering quality social relation-
ships high in emotional support among middle-aged
and older adults.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 29 of 31
Mogicetal. Systematic Reviews (2023) 12:86
Abbreviations
AD Alzheimer’s disease
ADL Activities of daily living
AMSTAR A Measurement Tool to Assess Systematic Reviews
MCI Mild cognitive impairment
NOS Newcastle–Ottawa Scale
PRISM A Preferred Reporting Items for Systematic Reviews and Meta Analyses
SWiM Synthesis Without Meta-Analysis
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s13643- 023- 02251-z.
Additional le1. PRISMA Checklist.
Additional le2. Search strategy used in PubMed database.
Additional le3. AMSTAR Checklist.
Acknowledgements
The authors thank the following persons for help with screening, data extrac-
tion, and risk of bias assessment: Shailesh Advani, Orna Awele Charles-Obazei,
Arden Fenton, Bailey Grigg, Laura Jimeñez, Mahwish Khan, Safa Khurram-
Hafeez, Peter Missiuna, Arsh Maira Muhammad Muhyiddin, Hamisha Ramesh,
Michelle Vuong, and Camilla Zienkiewicz. We also thank Jackie Stapleton for
devising the literature search strategy.
Authors’ contributions
Lana Mogic: Investigation, Data Curation, Writing – Original Draft, Visualiza-
tion Emily Rutter: Conceptualization, Investigation, Data Curation, Writ-
ing – Review and Editing, Supervision Suzanne Tyas: Conceptualization,
Methodology, Investigation, Writing – Review and Editing Colleen Maxwell:
Conceptualization, Methodology, Investigation, Writing – Review and Editing
Megan O’Connell: Investigation, Writing – Review and Editing, Mark Oremus:
Conceptualization, Methodology, Investigation, Writing – Review and Editing,
Visualization, Supervision, Project Administration, Funding Acquisition. The
author(s) read and approved the final manuscript.
Funding
This work was supported by Velux Stiftung (No. 1190) and the Canadian Insti-
tutes of Health Research (No. MM1 – 174917).
Availability of data and materials
The raw data extraction and risk of bias tables used during the current study
are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Received: 17 January 2023 Accepted: 7 May 2023
References
1. Robertson DA, Savva GM, Kenny RA. Frailty and cognitive impairment–a review
of the evidence and causal mechanisms. Ageing Res Rev. 2013;12:840–51.
2. Fillit HM, Butler RN, O’Connell AW, Albert MS, Birren JE, Cotman CW,
et al. Achieving and maintaining cognitive vitality with aging. Mayo Clin
Proc. 2002;77:681–96.
3. Cloutier S, Chertkow H, Kergoat M-J, Gauthier S, Belleville S. Patterns
of cognitive decline prior to dementia in persons with mild cognitive
impairment. J Alzheimers Dis. 2015;47:901–13.
4. Rutter EC, Tyas SL, Maxwell CJ, Law J, O’Connell ME, Konnert CA, et al.
Association between functional social support and cognitive function
in middle-aged and older adults: a protocol for a systematic review.
BMJ Open. 2020;10: e037301.
5. Ohman A, Maxwell CJ, Tyas SL, Oremus M. Subtypes of social support
availability are not differentially associated with memory: a cross-
sectional analysis of the Comprehensive Cohort of the Canadian Longi-
tudinal Study on Aging. Neuropsychol Dev Cogn B Aging Neuropsychol
Cogn. 2022;1–16. https:// doi. org/ 10. 1080/ 13825 585. 2022. 20302 94
6. Oremus M, Konner t C, Law J, Maxwell CJ, O’Connell ME, Tyas SL. Social sup-
port and cognitive function in middle- and older-aged adults: descriptive
analysis of CLSA tracking data. Eur J Public Health. 2019;29:1084–9.
7. Oremus M, Tyas SL, Maxwell CJ, Konnert C, O’Connell ME, Law J. Social
support availability is positively associated with memory in persons
aged 45–85 years: a cross-sectional analysis of the Canadian Longitudi-
nal Study on Aging. Arch Gerontol Geriatr. 2020;86: 103962.
8. Hugo J, Ganguli M. Dementia and cognitive impairment: epidemiology,
diagnosis, and treatment. Clin Geriatr Med. 2014;30:421–42.
9. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci
Med. 1991;32:705–14.
10. Wister A, Cosco T, Mitchell B, Menec V, Fyffe I. Development and
concurrent validity of a composite social isolation index for older adults
using the CLSA. Can J Aging. 2019;38:180–92.
11. Evans IEM, Llewellyn DJ, Matthews FE, Woods RT, Brayne C, Clare L.
Social isolation, cognitive reserve, and cognition in older people with
depression and anxiety. Aging Ment Health. 2019;23:1691–700.
12. Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel
ER, Stolk RP, et al. Social relationships and risk of dementia: a systematic
review and meta-analysis of longitudinal cohort studies. Ageing Res
Rev. 2015;22:39–57.
13. Kuiper JS, Zuidersma M, Zuidema SU, Burgerhof JGM, Stolk RP, Oude
Voshaar RC, et al. Social relationships and cognitive decline: a system-
atic review and meta-analysis of longitudinal cohort studies. Int J Epide-
miol. 2016;45:1169–206.
14. Lara E, Caballero FF, Rico-Uribe LA, Olaya B, Haro JM, Ayuso-Mateos
JL, et al. Are loneliness and social isolation associated with cognitive
decline? Int J Geriatr Psychiatry. 2019;34:1613–22.
15. Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al.
The impact of social activities, social networks, social support and social
relationships on the cognitive functioning of healthy older adults: a
systematic review. Syst Rev. 2017;6(1):259.
16. Murata C, Saito T, Saito M, Kondo K. The association between social
support and incident dementia: a 10-year follow-up study in Japan. Int
J Environ Res Public Health. 2019;16(2):239.
17. Pillemer S, Ayers E, Holtzer R. Gender-stratified analyses reveal longi-
tudinal associations between social support and cognitive decline in
older men. Aging Ment Health. 2019;23:1326–32.
18. Menec VH, Newall NE, Mackenzie CS, Shooshtari S, Nowicki S. Examin-
ing social isolation and loneliness in combination in relation to social
support and psychological distress using Canadian Longitudinal Study
of Aging (CLSA) data. PLoS One. 2020;15: e0230673.
19. Costa-Cordella S, Arevalo-Romero C, Parada FJ, Rossi A. Social support
and cognition: a systematic review. Front Psychol. 2021;12: 637060.
20. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD,
et al. The PRISMA 2020 statement: an updated guideline for reporting
systematic reviews. BMJ. 2021;372: n71.
21. GA wells, B Shea, D O’Connell, J Peterson, V Welch, M Losos, et al. The
Newcastle-Ottawa Scale (NOS) for assessing the quality of nonran-
domised studies in meta-analyses. Ottawa Hospital Research Institute;
2009 [Cited 2023 Jan 17]. Available from: https:// www. ohri. ca/ progr
ams/ clini cal_ epide miolo gy/ oxford. asp
22. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis
S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews:
reporting guideline. BMJ. 2020;368: l6890.
23. Bourgeois JA, John M, Zepf R, Greene M, Frankel S, Hessol NA. Func-
tional deficits and other psychiatric associations with abnormal scores
on the Montreal Cognitive Assessment (MoCA) in older HIV-infected
patients. Int Psychogeriatr. 2020;32:105–18.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 30 of 31
Mogicetal. Systematic Reviews (2023) 12:86
24. Ficker LJ, MacNeil SE, Bank AL, Lichtenberg PA. Cognition and perceived
social support among live-alone urban elders. J Appl Gerontol.
2002;21:437–51.
25. Crooks VC, Lubben J, Petitti DB, Little D, Chiu V. Social network, cogni-
tive function, and dementia incidence among elderly women. Am J
Public Health. 2008;98:1221–7.
26. Hudetz JA, Hoffmann RG, Patterson KM, Byrne AJ, Iqbal Z, Gandhi SD,
et al. Preoperative dispositional optimism correlates with a reduced
incidence of postoperative delirium and recovery of postoperative cog-
nitive function in cardiac surgical patients. J Cardiothorac Vasc Anesth.
2010;24:560–7.
27. Alpass F, Long N, Blakey J, Pachana N. Post-traumatic stress disorder,
social support and cognitive status in community-based older veterans.
Australas J Ageing. 2004;23:97–9.
28. Bourne VJ, Fox HC, Starr JM, Deary IJ, Whalley LJ. Social support in
later life: Examining the roles of childhood and adulthood cognition.
Personal Individ Differ. 2007;43:937–48.
29. Conroy RM, Golden J, Jeffares I, O’Neill D, McGee H. Boredom-
proneness, loneliness, social engagement and depression and their
association with cognitive function in older people: a population study.
Psychol Health Med. 2010;15:463–73.
30. Deng Q, Liu W. Inequalities in cognitive impairment among older adults
in China and the associated social determinants: a decomposition
approach. Int J Equity Health. 2021;20(1):82.
31. Frith E, Loprinzi PD. Social support and cognitive function in older
adults. Best Pract Ment Health Int J. 2017;13:41–9.
32. Ge S, Wu B, Bailey DE Jr, Dong X. Social support, social strain, and cogni-
tive function among community-dwelling U.S. Chinese older adults. J
Gerontol Biol Sci Med Sci. 2017;72:S16-21.
33. Gow AJ, Pattie A, Whiteman MC, Whalley LJ, Deary IJ. Social support
and successful aging: investigating the relationships between lifetime
cognitive change and life satisfaction. J Individ Differ. 2007;28:103–15.
34. Gow AJ, Corley J, Starr JM, Deary IJ. Which social network or support
factors are associated with cognitive abilities in old age? Gerontology.
2013;59:454–63.
35. Hamalainen A, Phillips N, Wittich W, Pichora-Fuller MK, Mick P. Sensory-cogni-
tive associations are only weakly mediated or moderated by social factors
in the Canadian Longitudinal Study on Aging. Sci Rep. 2019;9:19660.
36. Harling G, Kobayashi LC, Farrell MT, Wagner RG, Tollman S, Berkman L.
Social contact, social support, and cognitive health in a population-
based study of middle-aged and older men and women in rural South
Africa. Soc Sci Med. 2020;260: 113167.
37. Henderson AS, Scott R, Kay DW. The elderly who live alone: Their mental
health and social relationships. Aust N Z J Psychiatry. 1986;20:202–9.
38. Holtzman RE, Rebok GW, Saczynski JS, Kouzis AC, Wilcox Doyle K, Eaton
WW. Social network characteristics and cognition in middle-aged and
older adults. J Gerontol B Psychol Sci Soc Sci. 2004;59:P278–84.
39. Jang Y, Choi EY, Rhee MK, Park NS, Chiriboga DA, Kim MT. Determinants
of self-rated cognitive health among older Korean Americans. Geron-
tologist. 2020;60(2):250–8.
40. Keller-Cohen D, Fiori K, Toler A, Bybee D. Social relations, language and
cognition in the “oldest old.” Ageing Soc. 2006;26:585–605.
41. Kim JW, Kang HJ, Bae KY, Kim SW, Shin IS, Yoon JS, et al. Social support
deficit and depression treatment outcomes in patients with acute
coronary syndrome: findings from the EsDEPACS study. Int J Psychiatry
Med. 2019;54:39–52.
42. Kotwal AA, Kim J, Waite L, Dale W. Social function and cognitive status:
results from a US nationally representative survey of older adults. J Gen
Intern Med. 2016;31:854–62.
43. Krueger KR, Wilson RS, Kamenetsky JM, Barnes LL, Bienias JL, Bennett
DA. Social engagement and cognitive function in old age. Exp Aging
Res. 2009;35:45–60.
44. La Fleur CG, Salthouse TA. Which aspects of social support are associ-
ated with which cognitive abilities for which people? J Gerontol B
Psychol Sci Soc Sci. 2017;72:1006–16.
45. Lee H, Waite LJ. Cognition in context: the role of objective and subjec-
tive measures of neighborhood and household in cognitive function-
ing in later life. Gerontologist. 2018;58:159–69.
46. Mehrabi F, Béland F. Frailty as a moderator of the relationship between
social isolation and health outcomes in community-dwelling older
adults. Int J Environ Res Public Health. 2021;18(4):1675.
47. Millan-Calenti JC, Sanchez A, Lorenzo-Lopez L, Cao R, Maseda A. Influence
of social support on older adults with cognitive impairment, depressive
symptoms, or both coexisting. Int J Aging Hum Dev. 2013;76:199–214.
48. Murayama H, Ura C, Miyamae F, Sakuma N, Sugiyama M, Inagaki H, et al.
Ecological relationship between social capital and cognitive decline in
Japan: a preliminary study for dementia-friendly communities. Geriatr
Gerontol Int. 2019;19:950–5.
49. Nakamura ZM, Deal AM, Nyrop KA, Choi SK, Wood WA, Muss HB. Asso-
ciations of functional, psychosocial, medical, and socio-demographic
factors with cognitive screening in chemotherapy naive patients with
breast cancer. Psychooncology. 2019;28:167–73.
50. Okabayashi H, Liang J, Krause N, Akiyama H, Sugisawa H. Mental health
among older adults in Japan: do sources of social support and negative
interaction make a difference? Soc Sci Med. 2004;59:2259–70.
51. Pillemer SC, Holtzer R. The differential relationships of dimensions of
perceived social support with cognitive function among older adults.
Aging Ment Health. 2016;20:727–35.
52. Poey JL, Burr JA, Roberts JS. Social connectedness, perceived isolation,
and dementia: does the social environment moderate the relation-
ship between genetic risk and cognitive well-being? Gerontologist.
2017;57:1031–40.
53. Rashid A, Manan AA, Rohana S. The influence of social support on
cognitive impairment in the elderly. Australas Med J. 2016;9:262–9.
54. Saenz JL, Beam CR, Zelinski EM. The association between spousal
education and cognitive ability among older Mexican adults. J Gerontol
B Psychol Sci Soc Sci. 2020;75:E129–40.
55. Sims RC, Hosey M, Levy S-A, Whitfield KE, Katzel LI, Waldstein SR. Dis-
tinct functions of social support and cognitive function among older
adults. Exp Aging Res. 2014;40:40–59.
56. Weng X, George DR, Jiang B, Wang L. Association between subjective
cognitive decline and social and emotional support in US adults. Am
J Alzheimers Dis Other Demen. 2020. https:// doi. org/ 10. 1177/ 15333
17520 922392.
57. Yang Y. Characterising long term care needs among Chinese older
adults with cognitive impairment or ADL limitations. J Cross-Cult
Gerontol. 2020;35:35–47.
58. Yeh S-CJ, Liu Y-Y. Influence of social support on cognitive function in
the elderly. BMC Health Serv Res. 2003;3:9.
59. Zahodne LB, Nowinski CJ, Gershon RC, Manly JJ. Which psychosocial
factors best predict cognitive performance in older adults? J Int Neu-
ropsychol Soc. 2014;20:487–95.
60. Zahodne LB, Watson CW, Seehra S, Martinez MN. Positive psychosocial
factors and cognition in ethnically diverse older adults. J Int Neuropsy-
chol Soc. 2018;24:294–304.
61. Zank S, Leipold B. The relationship between severity of dementia and
subjective well-being. Aging Ment Health. 2001;5:191–6.
62. Zhaoyang R, Sliwinski MJ, Martire LM, Katz MJ, Scott SB. Features of daily
social interactions that discriminate between older adults with and
without mild cognitive impairment. J Gerontol B Psychol Sci Soc Sci.
2021. https:// doi. org/ 10. 1093/ geronb/ gbab0 19.
63. Zhu S, Hu J, Efird JT. Role of social support in cognitive function among
elders. J Clin Nurs. 2012;21:2118–25.
64. Zuelsdorff ML, Engelman CD, Friedman EM, Koscik RL, Jonaitis EM,
Rue AL, et al. Stressful events, social support, and cognitive function in
middle-aged adults with a family history of Alzheimer’s disease. J Aging
Health. 2013;25:944–59.
65. Zuelsdorff ML, Koscik RL, Okonkwo OC, Peppard PE, Hermann BP,
Sager MA, et al. Social support and verbal interaction are differentially
associated with cognitive function in midlife and older age. Aging
Neuropsychol Cogn. 2019;26:144–60.
66. Zullo L, Clark C, Gholam M, Castelao E, von Gunten A, Preisig M, et al.
Factors associated with subjective cognitive decline in dementia-
free older adults-a population-based study. Int J Geriatr Psychiatry.
2021;36:1188–96.
67. Amieva H, Stoykova R, Matharan F, Helmer C, Antonucci TC, Dartigues
JF. What aspects of social network are protective for dementia? Not
the quantity but the quality of social interactions is protective up to 15
years later. Psychosom Med. 2010;72:905–11.
68. Andel R, Crowe M, Hahn EA, Mortimer JA, Pedersen NL, Fratiglioni L,
et al. Work-related stress may increase the risk of vascular dementia. J
Am Geriatr Soc. 2012;60:60–7.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 31 of 31
Mogicetal. Systematic Reviews (2023) 12:86
69. Bedard M, Taler V. Social support buffers against cognitive decline in
single mild traumatic brain injury with loss of consciousness: results
from the Canadian Longitudinal Study on Aging. J Gerontol B Psychol
Sci Soc Sci. 2020;76(9):1777–87.
70. Bowling A, Pikhartova J, Dodgeon B. Is mid-life social participation
associated with cognitive function at age 50? Results from the British
National Child Development Study (NCDS). BMC Psychol. 2016;4(2):58.
71. Camozzato A, Godinho C, Varela J, Kohler C, Rinaldi J, Chaves M. The
complex role of having confidant on the development of Alzheimer’s
disease in a community-based cohort of older people in Brazil. Neu-
roepidemiology. 2015;44:78–82.
72. Chen TY, Chang HY. Developmental patterns of cognitive function and
associated factors among the elderly in Taiwan. Sci Rep. 2016;6:33486.
73. Chen L, Zhou R. Does self-reported hearing difficulty decrease older
adults’ cognitive and physical functioning? The mediating role of social
isolation. Maturitas. 2020;141:53–8.
74. Dickinson WJ, Potter GG, Hybels CF, McQuoid DR, Steffens DC. Change
in stress and social support as predictors of cognitive decline in
older adults with and without depression. Int J Geriatr Psychiatry.
2011;26:1267–74.
75. Eisele M, Zimmermann T, Kohler M, Wiese B, Heser K, Tebarth F, et al.
Influence of social support on cognitive change and mortality in old
age: results from the prospective multicentre cohort study AgeCoDe.
BMC Geriatr. 2012;12:9.
76. Ellwardt L, Aartsen M, Deeg D, Steverink N. Does loneliness mediate the
relation between social support and cognitive functioning in later life?
Soc Sci Med. 2013;98:116–24.
77. Heser K, Wagner M, Wiese B, Prokein J, Ernst A, Konig HH, et al. Asso-
ciations between dementia outcomes and depressive symptoms,
leisure activities, and social support. Dement Geriatr Cogn Disord.
2014;4:481–93.
78. Howrey BT, Raji MA, Masel MM, Peek MK. Stability in cognitive function
over 18 years: prevalence and predictors among older Mexican Ameri-
cans. Curr Alzheimer Res. 2015;12:614–21.
79. Hughes TF, Andel R, Small BJ, Borenstein AR, Mortimer JA. The associa-
tion between social resources and cognitive change in older adults:
Evidence from the Charlotte County Heath Aging Study. J Gerontol B
Psychol Sci Soc Sci. 2008;63:P241–4.
80. Kats D, Patel MD, Palta P, Meyer ML, Gross AL, Whitsel EA, et al. Social
support and cognition in a community-based cohort: the Atherosclero-
sis Risk in Communities (ARIC) study. Age Ageing. 2016;45:475–80.
81. Khondoker M, Rafnsson SB, Morris S, Orrell M, Steptoe A. Positive and
negative experiences of social support and risk of dementia in later
life: an investigation using the English Longitudinal Study of Ageing. J
Alzheimers Dis. 2017;58:99–108.
82. Khoo SS, Yang H. Social media use improves executive functions in
middle-aged and older adults: a structural equation modeling analysis.
Comput Hum Behav. 2020:106388.
83. Liao J, Muniz-Terrera G, Head J, Brunner EJ. Dynamic longitudinal
associations between social support and cognitive function: a prospec-
tive investigation of the directionality of associations. J Gerontol Ser B
Psychol Sci Soc Sci. 2018;73:1233–43.
84. Liao J, Scholes S. Association of social support and cognitive aging
modified by sex and relationship type: a prospective investiga-
tion in the English Longitudinal Study of Ageing. Am J Epidemiol.
2017;186:787–95.
85. Liu Y, Zhang S, Tomata Y, Otsuka T, Nurrika D, Sugawara Y, et al. Emo-
tional support (giving or receiving) and risk of incident dementia: The
Ohsaki Cohort 2006 Study. Arch Gerontol Geriatr. 2020;86: 103964.
86. Luo M, Edelsbrunner PA, Siebert JS, Martin M, Aschwanden D. Longi-
tudinal within-person associations between quality of social relations,
structure of social relations, and cognitive functioning in older age. J
Gerontol B Psychol Sci Soc Sci. 2021;76(10):1960–71.
87. Miyaguni Y, Tabuchi T, Aida J, Saito M, Tsuji T, Sasaki Y, et al. Community
social support and onset of dementia in older Japanese individuals: A
multilevel analysis using the JAGES cohort data. BMJ Open. 2021;11(6):
e044631.
88. Moreno GL, Ammann E, Kaseda ET, Espeland MA, Wallace R, Rob-
inson J, et al. The influence of social support on cognitive health in
older women: a Women’s Health Initiative study. J Women Aging.
2022;34(3):394–410.
89. Noguchi T, Nojima I, Inoue-Hirakawa T, Sugiura H. The association
between social support sources and cognitive function among
community-dwelling older adults: a one-year prospective study. Int J
Environ Res Public Health. 2019;16(21):4228.
90. Okely JA, Corley J, Welstead M, Taylor AM, Page D, Skarabela B, et al.
Change in physical activity, sleep quality, and psychosocial variables
during COVID-19 lockdown: evidence from the Lothian Birth Cohort
1936. Int J Environ Res Public Health. 2021;18:1–16.
91. Pais R, Ruano L, Moreira C, Fraga S, P Carvalho O, Barros H. Social
support and cognitive impairment: results from a Portuguese 4-year
prospective study. Int J Environ Res Public Health. 2021;18(16):8841.
92. Riddle M, McQuoid DR, Potter GG, Steffens DC, Taylor WD. Disability but
not social support predicts cognitive deterioration in late-life depres-
sion. Int Psychogeriatr. 2015;27:707–14.
93. Rote SM, Angel JL, Kim J, Markides KS. Dual trajectories of dementia
and social support in the Mexican-origin population. Gerontologist.
2021;61:374–82.
94. Saito T, Murata C, Saito M, Takeda T, Kondo K. Influence of social rela-
tionship domains and their combinations on incident dementia: a pro-
spective cohort study. J Epidemiol Community Health. 2018;72:7–12.
95. Salinas J, Beiser A, Himali JJ, Satizabal CL, Aparicio HJ, Weinstein G,
et al. Associations between social relationship measures, serum
brain-derived neurotrophic factor, and risk of stroke and dementia.
Alzheimers Dement. 2017;3:229–37.
96. Seeman TE, Lusignolo TM, Albert M, Berkman L. Social relationships,
social support, and patterns of cognitive aging in healthy, high-
functioning older adults: MacArthur Studies of Successful Aging. Health
Psychol. 2001;20:243–55.
97. Sörman DE, Rönnlund M, Sundström A, Adolfsson R, Nilsson LG. Social
relationships and risk of dementia: a population-based study. Int
Psychogeriatr. 2015;27(8):1391–9. https:// doi. org/ 10. 1017/ S1041 61021
50003 19.
98. Thomas PA, Umberson D. Do older parents’ relationships with their
adult children affect cognitive limitations, and does this differ for moth-
ers and fathers? J Gerontol Ser B Psychol Sci Soc Sci. 2018;73:1133–42.
99. Wilson RS, Boyle PA, James BD, Leurgans SE, Buchman AS, Bennett DA.
Negative social interactions and risk of mild cognitive impairment in
old age. Neuropsychology. 2015;29:561–70.
100. Yin S, Yang Q, Xiong J, Li T, Zhu X. Social support and the incidence of
cognitive impairment among older adults in China: findings from the
Chinese Longitudinal Healthy Longevity Survey Study. Front Psychiatry.
2020;11:254.
101. Zahodne LB, Sharifian N, Manly JJ, Sumner JA, Crowe M, Wadley VG,
et al. Life course biopsychosocial effects of retrospective childhood
social supportand later-life cognition. Psychol Aging. 2019;34:867–83.
102. Zahodne LB, Sharifian N, Kraal AZ, Sol K, Zaheed AB, Manly JJ, et al.
Positive psychosocial factors and cognitive decline in ethnically diverse
older adults. J Int Neuropsychol Soc. 2021;27:69–78.
103. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR
2: a critical appraisal tool for systematic reviews that include ran-
domised or non-randomised studies of healthcare interventions, or
both. BMJ. 2017;358: j4008.
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