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Chapter 9 - Social Relationships and Cognitive Function in Older Adults

from Part III - An Individual’s Cognitive Aging with Others: Key Findings, Issues, and Implications

Published online by Cambridge University Press:  28 September 2023

By
Hoyoung Kim
Edited by
Jeanyung Chey
Jeanyung Chey
Affiliation:
Seoul National University
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Summary

Cognitive health is one of the most important determinants of the quality of life and functional independence in older adults. Recently, social relationships have emerged as a protective factor against neurocognitive disorders and cognitive decline in old age. This chapter reviews the literature investigating the influence of structural and functional aspects of social relationships on dementia risk and cognitive function in older adults. For the structural aspects, it includes studies on the effects of social networks, social contacts, and social activity participation on cognitive function in older adults. For the functional aspects, it notes the influences of social support, social conflict, and loneliness on dementia risk and cognitive aging. Lastly, the chapter discusses the potential factors that mediate or modulate the relationship between social relationships and cognitive function.

Keywords

social networksocial activitysocial supportsocial conflictlonelinesscognitive agingdementia
Type
Chapter
Information
Society within the Brain
How Social Networks Interact with Our Brain, Behavior and Health as We Age
 , pp. 195 - 216
Publisher: Cambridge University Press
Print publication year: 2023

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References

Ajrouch, K. J., Blandon, A. Y., & Antonucci, T. C. (2005). Social networks among men and women: The effects of age and socioeconomic status. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(6), S311–S317.CrossRefGoogle ScholarPubMed
Amieva, H., Stoykova, R., Matharan, F., Helmer, C., Antonucci, T. C., & Dartigues, J.-F. (2010). 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. Psychosomatic Medicine, 72(9), 905–911.Google Scholar
Anstey, K. J., Cherbuin, N., & Herath, P. M. (2013). Development of a new method for assessing global risk of Alzheimer’s disease for use in population health approaches to prevention. Prevention Science, 14(4), 411–421.Google Scholar
Avlund, K., Lund, R., Holstein, B. E., Due, P., Sakari-Rantala, R., & Heikkinen, R.-L. (2004). The impact of structural and functional characteristics of social relations as determinants of functional decline. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(1), S44–S51.CrossRefGoogle ScholarPubMed
Barnes, L. L., De Leon, C. M., Wilson, R. S., Bienias, J. L., & Evans, D. A. (2004). Social resources and cognitive decline in a population of older African Americans and whites. Neurology, 63(12), 2322–2326.Google Scholar
Bassuk, S. S., Glass, T. A., & Berkman, L. F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of Internal Medicine, 131(3), 165–173.CrossRefGoogle ScholarPubMed
Béland, F., Zunzunegui, M.-V., Alvarado, B., Otero, A., & Del Ser, T. (2005). Trajectories of cognitive decline and social relations. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(6), P320–P330.CrossRefGoogle ScholarPubMed
Bennett, D. A., Schneider, J. A., Tang, Y., Arnold, S. E., & Wilson, R. S. (2006). The effect of social networks on the relation between Alzheimer’s disease pathology and level of cognitive function in old people: A longitudinal cohort study. The Lancet Neurology, 5(5), 406–412.CrossRefGoogle ScholarPubMed
Bielak, A. A. (2010). How can we not “lose it” if we still don’t understand how to “use it”? Unanswered questions about the influence of activity participation on cognitive performance in older age – A mini-review. Gerontology, 56(5), 507–519.Google Scholar
Brown, C. L., Gibbons, L. E., Kennison, R. F., Robitaille, A., Lindwall, M., Mitchell, M. B., Shirk, S. D., Atri, A., Cimino, C. R., Benitez, A., Macdonald, S. W., Zelinski, E. M., Willis, S. L., Schaie, K. W., Johansson, B., Dixon, R. A., Mungas, D. M., Hofer, S. M., & Piccinin, A. M. (2012). Social activity and cognitive functioning over time: A coordinated analysis of four longitudinal studies. Journal of Aging Research, 2012, 287438.CrossRefGoogle Scholar
Chan, D., Shafto, M., Kievit, R., Matthews, F., Spink, M., Valenzuela, M., & Henson, R. N. (2018). Lifestyle activities in mid-life contribute to cognitive reserve in late-life, independent of education, occupation, and late-life activities. Neurobiology of Aging, 70, 180–183.CrossRefGoogle ScholarPubMed
Choi, J., Kim, H., & Youm, Y. (2016). Social network, social support, social conflict and mini-mental state examination scores of rural older adults: Differential associations across relationship types. Journal of Korean Geriatric Psychiatry 20(2), 8.Google Scholar
Clare, L., Wu, Y.-T., Teale, J. C., MacLeod, C., Matthews, F., Brayne, C., Woods, B., & Team, C.-W. S. (2017). Potentially modifiable lifestyle factors, cognitive reserve, and cognitive function in later life: A cross-sectional study. PLoS Medicine, 14(3), e1002259.Google Scholar
Cohen, S. (2004). Social relationships and health. American Psychologist, 59(8), 676–684.CrossRefGoogle ScholarPubMed
Cornwell, B., Laumann, E. O., & Schumm, L. P. (2008). The social connectedness of older adults: A national profile. American Sociological Review, 73(2), 185–203.CrossRefGoogle ScholarPubMed
Crooks, V. C., Lubben, J., Petitti, D. B., Little, D., & Chiu, V. (2008). Social network, cognitive function, and dementia incidence among elderly women. American Journal of Public Health, 98(7), 1221–1227.CrossRefGoogle ScholarPubMed
Daviglus, M. L., Bell, C. C., Berrettini, W., Bowen, P. E., Connolly, E. S., Jr., Cox, N. J., Dunbar-Jacob, J. M., Granieri, E. C., Hunt, G., McGarry, K., Patel, D., Potosky, A. L., Sanders-Bush, E., Silberberg, D., & Trevisan, M. (2010). NIH state-of-the-science conference statement: Preventing Alzheimer’s disease and cognitive decline. NIH consensus and state-of-the-science statements, 27(4), 1–30.Google ScholarPubMed
DeVries, A. C., Glasper, E. R., & Detillion, C. E. (2003). Social modulation of stress responses. Physiology & Behavior, 79(3), 399–407.Google Scholar
Donovan, N. J., Wu, Q., Rentz, D. M., Sperling, R. A., Marshall, G. A., & Glymour, M. M. (2017). Loneliness, depression and cognitive function in older U.S. adults. International Journal of Geriatric Psychiatry, 32(5), 564–573.CrossRefGoogle ScholarPubMed
Ellwardt, L., Aartsen, M., Deeg, D., & Steverink, N. (2013). Does loneliness mediate the relation between social support and cognitive functioning in later life? Social Science & Medicine, 98, 116–124.CrossRefGoogle ScholarPubMed
Elovainio, M., Sommerlad, A., Hakulinen, C., Pulkki-Råback, L., Virtanen, M., Kivimäki, M., & Singh-Manoux, A. (2018). Structural social relations and cognitive ageing trajectories: Evidence from the Whitehall II cohort study. International Journal of Epidemiology, 47(3), 701–708.CrossRefGoogle ScholarPubMed
Erickson, K. I., & Kramer, A. F. (2009). Aerobic exercise effects on cognitive and neural plasticity in older adults. British Journal of Sports Medicine, 43(1), 22–24.Google Scholar
Ertel, K. A., Glymour, M. M., & Berkman, L. F. (2008). Effects of social integration on preserving memory function in a nationally representative US elderly population. American Journal of Public Health, 98(7), 1215–1220.CrossRefGoogle Scholar
Etnier, J. (2007). Interrelationships of exercise, mediator variables, and cognition. In Spirduso, W. W., Poon, L. W., & Chodzko-Zajko, W. J. (eds.), Exercise and Its Mediating Effects on Cognition, vol. 2, pp. 13–30. Human Kinetics.Google Scholar
Evans, I. E., Martyr, A., Collins, R., Brayne, C., & Clare, L. (2019). Social isolation and cognitive function in later life: A systematic review and meta-analysis. Journal of Alzheimer’s Disease, 70(s1), S119–S144.CrossRefGoogle ScholarPubMed
Fisk, J. E., & Sharp, C. A. (2004). Age-related impairment in executive functioning: Updating, inhibition, shifting, and access. Journal of Clinical and Experimental Neuropsychology, 26 (7), 874–890.Google Scholar
Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. The Lancet Neurology, 3(6), 343–353.CrossRefGoogle ScholarPubMed
Fratiglioni, L., Wang, H.-X., Ericsson, K., Maytan, M., & Winblad, B. (2000). Influence of social network on occurrence of dementia: A community-based longitudinal study. The Lancet, 355(9212), 1315–1319.Google Scholar
Gazzaley, A., Cooney, J. W., Rissman, J., & D’Esposito, M. (2005). Top-down suppression deficit underlies working memory impairment in normal aging. Nature Neuroscience, 8 (10), 1298–1300.CrossRefGoogle ScholarPubMed
Giles, L. C., Anstey, K. J., Walker, R. B., & Luszcz, M. A. (2012). Social networks and memory over 15 years of followup in a cohort of older Australians: Results from the Australian longitudinal study of ageing. Journal of Aging Research, 2012, 856048.Google Scholar
Glei, D. A., Landau, D. A., Goldman, N., Chuang, Y.-L., Rodríguez, G., & Weinstein, M. (2005). Participating in social activities helps preserve cognitive function: An analysis of a longitudinal, population-based study of the elderly. International Journal of Epidemiology, 34(4), 864–871.Google Scholar
Gorelick, P. B., Scuteri, A., Black, S. E., DeCarli, C., Greenberg, S. M., Iadecola, C., Launer, L. J., Laurent, S., Lopez, O. L., & Nyenhuis, D. (2011). Vascular contributions to cognitive impairment and dementia: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(9), 2672–2713.Google Scholar
Gow, A. J., Corley, J., Starr, J. M., & Deary, I. J. (2013). Which social network or support factors are associated with cognitive abilities in old age? Gerontology, 59(5), 454–463.Google Scholar
Green, A. F., Rebok, G., & Lyketsos, C. G. (2008). Influence of social network characteristics on cognition and functional status with aging. International Journal of Geriatric Psychiatry, 23(9), 972–978.Google Scholar
Hedden, T., & Gabrieli, J. D. (2004). Insights into the ageing mind: A view from cognitive neuroscience. Nature Reviews Neuroscience, 5(2), 87–96.Google Scholar
Hendrie, H. C., Albert, M. S., Butters, M. A., Gao, S., Knopman, D. S., Launer, L. J., Yaffe, K., Cuthbert, B. N., Edwards, E., & Wagster, M. V. (2006). The NIH Cognitive and Emotional Health Project. Report of the Critical Evaluation Study Committee. Alzheimer’s & Dementia, 2(1), 12–32.CrossRefGoogle ScholarPubMed
Henry, J. D., MacLeod, M. S., Phillips, L. H., & Crawford, J. R. (2004). A Meta-analytic review of prospective memory and aging. Psychology and Aging, 19 (1), 27–39.Google Scholar
Hertzog, C., Kramer, A. F., Wilson, R. S., & Lindenberger, U. (2008). Enrichment effects on adult cognitive development: Can the functional capacity of older adults be preserved and enhanced? Psychological Science in the Public Interest, 9(1), 1–65.Google Scholar
Holtzman, R. E., Rebok, G. W., Saczynski, J. S., Kouzis, A. C., Wilcox Doyle, K., & Eaton, W. W. (2004). Social network characteristics and cognition in middle-aged and older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(6), P278–P284.CrossRefGoogle ScholarPubMed
Hughes, T. F., Andel, R., Small, B. J., Borenstein, A. R., & Mortimer, J. A. (2008). The association between social resources and cognitive change in older adults: Evidence from the Charlotte County Healthy Aging Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 63(4), P241–P244.Google Scholar
Ihle, A., Oris, M., Fagot, D., Baeriswyl, M., Guichard, E., & Kliegel, M. (2015). The association of leisure activities in middle adulthood with cognitive performance in old age: The moderating role of educational level. Gerontology, 61(6), 543–550.Google Scholar
James, B. D., Wilson, R. S., Barnes, L. L., & Bennett, D. A. (2011). Late-life social activity and cognitive decline in old age. Journal of the International Neuropsychological Society, 17(6), 998–1005.CrossRefGoogle ScholarPubMed
Kang, S., Kim, H., & Youm, Y. (2016). Influence of social activity on cognitive function in older adults: Moderating effects of education. Korean Journal of Psychology: General, 35(4), 525–549.Google Scholar
Kelly, M. E., Duff, H., Kelly, S., McHugh Power, J. E., Brennan, S., Lawlor, B. A., & Loughrey, D. G. (2017). The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: A systematic review. Systematic Reviews, 6(1), 259.Google Scholar
Kray, J., Li, K. Z., & Lindenberger, U. (2002). Age-related changes in task-switching components: The role of task uncertainty. Brain and Cognition, 49 (3), 363–381.CrossRefGoogle ScholarPubMed
Kuiper, J. S., Zuidersma, M., Oude Voshaar, R. C., Zuidema, S. U., van den Heuvel, E. R., Stolk, R. P., & Smidt, N. (2015). Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 22, 39–57.CrossRefGoogle ScholarPubMed
Kuiper, J. S., Zuidersma, M., Zuidema, S. U., Burgerhof, J. G., Stolk, R. P., Oude Voshaar, R. C., & Smidt, N. (2016). Social relationships and cognitive decline: A systematic review and meta-analysis of longitudinal cohort studies. International Journal of Epidemiology, 45(4), 1169–1206.Google Scholar
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157–171.CrossRefGoogle ScholarPubMed
Liao, J., & Scholes, S. (2017). Association of social support and cognitive aging modified by sex and relationship type: A prospective investigation in the English Longitudinal Study of Ageing. American Journal of Epidemiology, 186(7), 787–795.Google Scholar
Lupien, S. J., Schwartz, G., Ng, Y. K., Fiocco, A., Wan, N., Pruessner, J. C., Meaney, M. J., & Nair, N. P. (2005). The Douglas Hospital Longitudinal Study of Normal and Pathological Aging: Summary of findings. Journal of Psychiatry and Neuroscience, 30(5), 328–334.Google Scholar
McDonough, I. M., Haber, S., Bischof, G. N., & Park, D. C. (2015). The Synapse Project: Engagement in mentally challenging activities enhances neural efficiency. Restorative Neurology and Neuroscience, 33(6), 865–882.Google Scholar
McHugh Power, J., Tang, J., Lawlor, B., Kenny, R. A., & Kee, F. (2018). Mediators of the relationship between social activities and cognitive function among older Irish adults: Results from the Irish Longitudinal Study on Ageing. Aging & Mental Health, 22(1), 129–134.Google Scholar
Nguyen, L., Murphy, K., & Andrews, G. (2019). Cognitive and neural plasticity in old age: A systematic review of evidence from executive functions cognitive training. Ageing Research Reviews, 53, 100912.Google Scholar
Nyberg, L., Lövdén, M., Riklund, K., Lindenberger, U., & Bäckman, L. (2012). Memory aging and brain maintenance. Trends in Cognitive Sciences, 16 (5), 292–305.Google Scholar
Pahl, R., & Pevalin, D. J. (2005). Between family and friends: A longitudinal study of friendship choice. The British Journal of Sociology, 56(3), 433–450.Google Scholar
Park, D. C., & Bischof, G. N. (2013). The aging mind: Neuroplasticity in response to cognitive training. Dialogues in Clinical Neuroscience, 15(1), 109–119.Google Scholar
Park, D. C., Lautenschlager, G., Hedden, T., Davidson, N. S., Smith, A. D., & Smith, P. K. (2002). Models of visuospatial and verbal memory across the adult life span. Psychology and Aging, 17 (2), 299.Google Scholar
Park, D. C., Lodi-Smith, J., Drew, L., Haber, S., Hebrank, A., Bischof, G. N., & Aamodt, W. (2014). The impact of sustained engagement on cognitive function in older adults: The Synapse Project. Psychological Science, 25(1), 103–112.Google Scholar
Penn, D. L., Corrigan, P. W., Bentall, R. P., Racenstein, J. M., & Newman, L. (1997). Social cognition in schizophrenia. Psychological Bulletin, 121(1), 114–132.Google Scholar
Polidori, M. C., Nelles, G., & Pientka, L. (2010). Prevention of dementia: Focus on lifestyle. International Journal of Alzheimer’s Disease, 2010, 393579.Google Scholar
Richards, M., & Deary, I. J. (2005). A life course approach to cognitive reserve: A model for cognitive aging and development? Annals of Neurology, 58(4), 617–622.Google Scholar
Rose, N. S., Rendell, P. G., Hering, A., Kliegel, M., Bidelman, G. M., & Craik, F. I. M. (2015). Cognitive and neural plasticity in older adults’ prospective memory following training with the Virtual Week computer game. Frontiers in Human Neuroscience, 9(592), 1–13.CrossRefGoogle ScholarPubMed
Rowe, J. W., & Kahn, R. L. (1987). Human aging: Usual and successful. Science, 237(4811), 143–149.Google Scholar
Salthouse, T. A. (2010). Selective review of cognitive aging. Journal of the International Neuropsychological Society, 16(5), 754–760.Google Scholar
Scarmeas, N., & Stern, Y. (2003). Cognitive reserve and lifestyle. Journal of Clinical and Experimental Neuropsychology, 25(5), 625–633.CrossRefGoogle ScholarPubMed
Seeman, T. E., Lusignolo, T. M., Albert, M., & Berkman, L. (2001). Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. Health Psychology, 20(4), 243–255.Google Scholar
Seeman, T. E., Miller-Martinez, D. M., Stein Merkin, S., Lachman, M. E., Tun, P. A., & Karlamangla, A. S. (2011). Histories of social engagement and adult cognition: Midlife in the U.S. study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 66 (Suppl 1), i141–i152.Google Scholar
Shankar, A., Hamer, M., McMunn, A., & Steptoe, A. (2013). Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosomatic Medicine, 75(2), 161–170.Google Scholar
Sharifian, N., Manly, J. J., Brickman, A. M., & Zahodne, L. B. (2019). Social network characteristics and cognitive functioning in ethnically diverse older adults: The role of network size and composition. Neuropsychology, 33(7), 956–963.Google Scholar
Small, B. J., Dixon, R. A., McArdle, J. J., & Grimm, K. J. (2012). Do changes in lifestyle engagement moderate cognitive decline in normal aging? Evidence from the Victoria Longitudinal Study. Neuropsychology, 26(2), 144–155.CrossRefGoogle ScholarPubMed
Stern, Y. (2009). Cognitive reserve. Neuropsychologia, 47(10), 2015–2028.CrossRefGoogle ScholarPubMed
Sutin, A. R., Stephan, Y., Luchetti, M., & Terracciano, A. (2020). Loneliness and risk of dementia. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 75(7), 1414–1422.Google Scholar
Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119(3), 488–531.Google Scholar
Wang, H.-X., Karp, A., Winblad, B., & Fratiglioni, L. (2002). Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: A longitudinal study from the Kungsholmen project. American Journal of Epidemiology, 155(12), 1081–1087.Google Scholar
Wecker, N. S., Kramer, J. H., Hallam, B. J., & Delis, D. C. (2005). Mental flexibility: Age effects on switching. Neuropsychology, 19 (3), 345–352.Google Scholar
West, R., & Alain, C. (2000). Age-related decline in inhibitory control contributes to the increased Stroop effect observed in older adults. Psychophysiology, 37 (2), 179–189.CrossRefGoogle Scholar
Wilson, R. S., Arnold, S. E., Schneider, J. A., Kelly, J. F., Tang, Y., & Bennett, D. A. (2006). Chronic psychological distress and risk of Alzheimer’s disease in old age. Neuroepidemiology, 27(3), 143–153.Google Scholar
Wilson, R. S., Barnes, L. L., Krueger, K. R., Hoganson, G., Bienias, J. L., & Bennett, D. A. (2005). Early and late life cognitive activity and cognitive systems in old age. Journal of the International Neuropsychological Society, 11(4), 400–407.Google Scholar
Wilson, R. S., Boyle, P. A., James, B. D., Leurgans, S. E., Buchman, A. S., & Bennett, D. A. (2015). Negative social interactions and risk of mild cognitive impairment in old age. Neuropsychology, 29(4), 561–570.Google Scholar
Windsor, T. D., Gerstorf, D., Pearson, E., Ryan, L. H., & Anstey, K. J. (2014). Positive and negative social exchanges and cognitive aging in young-old adults: Differential associations across family, friend, and spouse domains. Psychology and Aging, 29(1), 28–43.CrossRefGoogle ScholarPubMed
Xu, H., Yang, R., Qi, X., Dintica, C., Song, R., Bennett, D. A., & Xu, W. (2019). Association of lifespan cognitive reserve indicator with dementia risk in the presence of brain pathologies. JAMA Neurology, 76(10), 1184–1191.Google Scholar
Yang, R., Wang, H., Edelman, L. S., Tracy, E. L., Demiris, G., Sward, K. A., & Donaldson, G. W. (2020). Loneliness as a mediator of the impact of social isolation on cognitive functioning of Chinese older adults. Age and Ageing, 49(4), 599–604.Google Scholar
Ybarra, O., Burnstein, E., Winkielman, P., Keller, M. C., Manis, M., Chan, E., & Rodriguez, J. (2008). Mental exercising through simple socializing: Social interaction promotes general cognitive functioning. Personality and Social Psychology Bulletin, 34(2), 248–259.Google Scholar
Yim, J., Kim, H., & Youm, Y. (2016). The effect of social support and conflict in different types of relationships on depression and suicidal ideation among the young-old and the old-old. Korean Journal of Clinical Psychology 35(3), 645–657.Google Scholar
Zunzunegui, M.-V., Alvarado, B. E., Del Ser, T., & Otero, A. (2003). Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(2), S93–S100.Google Scholar

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