Could loneliness be an early sign of Alzheimer's disease?
Subtle feelings of loneliness could warn that Alzheimer's disease is imminent in older people, a new study suggests. Researchers have found that healthy older adults with elevated brain levels of amyloid - a type of protein fragment associated with Alzheimer's disease - are more likely to feel lonely than those with low levels of it.
"For people who have high levels of amyloid they are 7.5 times more likely to be alone than non-lonely people," said lead researcher Dr. Nancy Donovan. She is director of the Alzheimer's Treatment and Research Center at Brigham and Women's Hospital in Boston. On the other hand, studies have shown that people who remain socially active are less likely to develop dementia, Donovan said. But the results of the new study suggest that that relationship may work the other way around, too - that people in the early stages of Alzheimer's disease may be more likely to feel lonely or socially separate. "People who are beginning to accumulate amyloid may not be functioning as well in terms of perceiving, understanding or responding to stimuli or social interactions," said Donovan. "This could be an early social sign of cognitive [mental] change." If this is proven, then doctors may be able to detect Alzheimer's disease by paying more attention to the emotional health of patients, he suggested. Plaques in the brain formed from sticky amyloid proteins are a hallmark of Alzheimer's disease, the most common cause of dementia, according to the United States National Institutes of Health. These plaques form in the spaces between nerve cells in the brain of Alzheimer's patients, although their connection to the disease is not fully understood at this time. To examine the relationship between late loneliness and Alzheimer's risk, Donovan and his colleagues examined 43 women and 36 men, with an average age of 76 years. All were healthy, with no signs of Alzheimer's or dementia. The researchers used standard psychological tests to measure each person's degree of loneliness, and imaging scans to detect the amount of amyloid protein in their brains. The researchers particularly focused on amyloid levels in the cerebral cortex, a part of the brain that plays a key role in memory, attention, perception, and thinking.
People with high levels of amyloid in the cortex were 7.5 times more likely to be classified as feeling lonely, even after the researchers classified them as socially active, as well as if they had suffered from depression or anxiety. Taking into account the extent of the person's social network, Donovan's team showed that seniors who feel isolated or socially separated, even when surrounded by friends or family, could be at high risk for Alzheimer's.
However, the study does not prove a direct cause and effect relationship between the two. Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Heatlh in Great Neck, NY, said this finding is "very new" and could point to new ways of associating a person's emotions with dementia risk. However, this study was conducted in a very small group of older adults in Boston, a city where people tend to be better educated and can be more in touch with their emotions, Wolf-Klein added. Larger studies involving different types of people are needed to validate these findings, he said. "If this is corroborated by other larger studies, then the question would be, what kind of intervention might result?" Wolf-Klein said. "If you could impact this loneliness by creating interventions where people were taken out of their loneliness and engaged in social events, would you have less chance of progression to dementia?" Dean Hartley is director of scientific initiatives, medical relations and science at the Alzheimer's Association. Hartley said that in the early stages of Alzheimer's disease, there may be "behavioral changes that can be a symptom of mild cognitive impairment or dementia." Doctors in the future may be trained to look for loneliness, apathy, mood swings or social impulsivity as early signs of Alzheimer's disease, he said. "We think this [the new find] is important, and I have a feeling we'll see more of it," Hartley said. "As we develop treatments for Alzheimer's, the earlier you diagnose and the sooner it is treated, the better the results."
10 early signs of Alzheimer's disease:
Are you worried about your mental acuity? Or maybe that of a loved one? Mild forgetfulness can be a normal part of aging. If you have trouble remembering someone's name but it comes to you later, that is not a serious memory problem. But if memory problems are seriously affecting your daily life, they could be early signs of Alzheimer's disease. While the number of symptoms you have and how strong they are vary, it is important to identify the early signs. You have to ask yourself some tough questions.
1. Memory loss This is the most common symptom. Do you easily forget the information you just learned? Lost track of important dates, names, and events? Are you forgetting important things that have happened? Do you ask for the same information over and over again? Relying heavily on memory aids like post-it notes or reminders on your smartphone?
2. Problem planning and troubleshooting Having trouble making plans and sticking with them? Is it difficult to follow a recipe, even one that you have used many times? Is it difficult to focus on detailed tasks, especially if they involve numbers? For example, can you keep track of your bills and balance your checkbook?
3. Daily tasks are challenging Even familiar things can get difficult. Are you having trouble driving to a place you go often? Can you complete a normal task at work? Forget the rules of your favorite game?
4. Times and places are confusing Can you fully understand something that is not happening right now? Are you disoriented? Is it easily lost? Did you forget where you are? Do you remember how you got there?
5. Changes in vision Is it harder to read the words on the page? Do you have trouble judging the distance? Can you distinguish the colors? This is important because it can affect your driving.
6. Words and conversations are frustrating The vocabulary becomes difficult. Can you find the correct word you are looking for? Or do you call things by the wrong name? Conversations can be a struggle. Avoid joining? Are you able to move on? Do you suddenly stop in the middle of an argument because you don't know what to say? Do you keep repeating yourself?
7. You lose things Everyone shifts things from time to time, but can you retrace your steps to find them again? Do you put things in unusual places, like your watch on the refrigerator? Do you accuse people of taking things?
8. Judgment lapse Have you made bad decisions lately? Do you make mistakes with money, like giving it away when you normally wouldn't? Are you showering frequently? Do you take care of yourself less? Do you dress for the weather?
9. Social retreat Are you cutting back on your projects at work? Are you less involved with your favorite hobbies? Do you lack motivation? Are you watching television or sleeping more than usual?
10. Humor changes Are you more easily upset? Are you feeling depressed, scared, or anxious? Are you suspicious of people?
See your Doctor If you notice these signs, talk to your doctor. They will evaluate your physical and mental health. They will examine your medical history and perform a mental status test, which will test your memory, simple problem solving ability, and thinking skills. You can also do blood or brain imaging tests. Your doctor may then refer you to someone who specializes in Alzheimer's, such as a neurologist (a doctor who specializes in treating the brain and nervous system), psychiatrist, psychologist, or geriatrician (a doctor who specializes in treating older people). . You can also find a specialist through your local Alzheimer's Association or the Centers for Alzheimer's Disease.
Nancy Donovan, MD, professor, neurology, Harvard Medical School and director, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston;
Gisele Wolf-Klein, MD, director, geriatric education, Northwell Health, Great Neck, NY;
Dean Hartley, Ph.D., director of science initiatives, medical and scientific relations for the Alzheimer's Association; Nov. 2, 2016, JAMA Psychiatry, online
Alzheimer's Association: "10 Early Signs and Symptoms of Alzheimer's," "Diagnosis of Alzheimer's Disease and Dementia," "What Is Dementia?"
University of California San Francisco: "Alzheimer's Disease Signs and Symptoms."
National Institute on Aging: "Forgetfulness: Knowing When To Ask For Help."
American Psychological Association: "Aging: When should I be concerned about a senior's forgetfulness?"
Reviewed by Neil Lava, MD on January 15, 2015
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