Changes in social relationships could signal early cognitive decline.

Small changes in the social lives of older people are early red flags showing that their thought processes and brain functioning could be on the decline. This is according to Ashwin Kotwal of Brigham and Women's Hospital in the US, who led a study in the Journal of General Internal Medicine, published by Springer.

Data from the National Social Life Health and Aging Project (NSHAP)1 was analyzed. This nationally representative survey included 3,310 people between 62 and 90 years old still living in their communities. Respondents were screened for early evidence of cognitive decline, and they were categorized into three groups: those having normal brain functioning, those with mild cognitive impairment (MCI) and those suffering from dementia. Participants were questioned about the density and size of their social networks, the support they receive from others, the amount of social strain they experience, and their attendance at community events. They were also asked with whom they discussed important matters and how much they socialized with family and friends.

Important changes were noted in the social lives of people who have signs of early cognitive decline. Their social networks are smaller, more interconnected, and contain a higher proportion of relatives (65 percent for the normal group versus 73 percent for the dementia group). According to Dr. Kotwal, this could be because lower cognition makes it difficult to maintain diverse and distant ties, such as their usual circle of friends. It could also reflect how people and families start to compensate when their loved ones have cognitive losses and need more support.

"Such new circumstances may require more densely linked, family-centered networks to help monitor and support the health of individuals showing signs of even early impairment," Kotwal adds.

Men in the group with MCI or dementia felt they received more encouragement from their spouses than before. Women in these groups said there was a drop in the support from friends. According to Kotwal, even a mild decrease in cognition could change how women mobilize needed social support.

Findings from these same two groups (MCI and dementia) also showed that, while there was no difference in how much women socialized with friends and neighbors, men socialize nearly 15 percent more than before. This could reflect the way men become more reliant on those closer to them, as they start to suffer from the effects of old age including cognitive decline and the contraction of their larger network. Kotwal says it could also be that people close to them tend to check in more on men with cognitive difficulties than they do when women are in the same position. People whose cognitive abilities are declining also participated less in community activities, group activities and volunteer work.

These results can help clinicians better understand how changes in an older person's social relationships could be signalling the onset of cognitive impairment, something that should be rasied with a person's medical provider.

"We hope that these findings will help clinicians better identify social vulnerabilities in those at risk for early cognitive loss. The information could help ease the transition to overt dementia for both patients and caregivers, should progression occur," says Kotwal.

Social Function and Cognitive Status: Results from a US Nationally Representative Survey of Older Adults. Ashwin A. Kotwal, Juyeon Kim, Linda Waite, William Dale. Journal of General Internal Medicine. DOI:10.1007/s11606-016-3696-0. Published online 29 April 2016.