Loneliness, Not Social Support, Is Associated with Cognitive Decline and Dementia Across Two Longitudinal Population-Based Cohorts

Rosanne Freak-Poli, Nina Wagemaker, Rui Wang, Thom S. Lysen, M. Arfan Ikram, Meike W. Vernooij, Christina S. Dintica, Myrra Vernooij-Dassen, Rene J.F. Melis, Erika J. Laukka, Laura Fratiglioni, Weili Xu, Henning Tiemeier*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)


Background: Poor social health is likely associated with cognitive decline and risk of dementia; however, studies show inconsistent results. Additionally, few studies separate social health components or control for mental health. Objective: To investigate whether loneliness and social support are independently associated with cognitive decline and risk of dementia, and whether depressive symptoms confound the association. Methods: We included 4,514 participants from the population-based Rotterdam Study (RS; aged 71±7SD years) followed up to 14 years (median 10.8, interquartile range 7.4-11.6), and 2,112 participants from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; aged 72±10SD years) followed up to 10 years (mean 5.9±1.6SD). At baseline, participants were free of major depression and scored on the Mini-Mental State Examination (MMSE) ≥26 for RS and ≥25 for SNAC-K. We investigated loneliness, perceived social support, and structural social support (specifically marital status and number of children). In both cohorts, dementia was diagnosed and cognitive function was repeatedly assessed with MMSE and a global cognitive factor (g-factor). Results: Loneliness was prospectively associated with a decline in the MMSE in both cohorts. Consistently, persons who were lonely had an increased risk of developing dementia (RS: HR 1.34, 95%CI 1.08-1.67; SNAC-K: HR 2.16, 95%CI 1.12-4.17). Adjustment for depressive symptoms and exclusion of the first 5 years of follow-up did not alter results. Neither perceived or structural social support was associated with cognitive decline or dementia risk. Conclusion: Loneliness, not social support, predicted cognitive decline and incident dementia independently of depressive symptoms.

Original languageEnglish
Pages (from-to)295-308
Number of pages14
JournalJournal of Alzheimer's Disease
Issue number1
Publication statusPublished - 4 Jan 2022

Bibliographical note

The contributions of participants of the Rotterdam Study and general practitioners and pharmacists of Ommoord, Rotterdam are gratefully acknowledged. Likewise, we thank all participants and staff involved in data collection and management in the Swedish National Study on Aging and Care in Kungsholmen.

This project is part of the CoSTREAM consortium (www.costream.eu) and received funding from the European Union’s Horizon 2020 research and innovation programme (grant no. 667375).

The Rotterdam Study is supported by the Erasmus MC University Medical Center the Netherlands Organisation for Scientific Research (NWO), The Netherlands Organisation for Health Research and Development (ZonMW), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. This work was partly supported by the JPND project Social Health And Reserve in the Dementia patient journey (SHARED) and financed through projects funded by the Netherlands Organisation for Health Research and Development (grant numbers 733051082 and 733050831). Henning Tiemeier received support from a ZonMW VICI grant (016.VICI.170.200). Rosanne Freak-Poli is supported by a Heart Foundation of Australia post-doctoral fellowship (101927).

SNAC-K (http://www.snac.org) is financially supported by the Swedish Ministry of Health and Social Affairs; the participating county councils and municipalities; the Swedish Research Council; and the Swedish Research Council for Health, Working Life and Welfare. Weili Xu received grants from the Swedish Research Council (No 2017-00981), the Konung Gustaf V:soch Drottning Victorias Frimurare Foundation (No. 2018-2019), Demensfonden (2018) and Alzheimerfonden (2018–2019).

None of the funding organizations or sponsors were involved in the design and conduct of the study; collection, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/21-0330r2).

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