Consequences of social isolation during the COVID-19 pandemic in older adults with and without Alzheimer's disease

新冠肺炎疫情仅在美国就造成了50多万人死亡。即使是为了 那些身体健康和经济安全没有受到影响的个人， 大流行导致的孤立对心理和认知健康的影响可能是深远的- 尤其是对我们的退伍军人来说。在大流行之前，大约10%的老年退伍军人报告说 经常感到孤独，40%的人表示有时会感到孤独。由于社会疏远 指导方针和其他限制社会接触的措施，大流行期间的孤独很可能 远远超过了这些估计。几十年的研究已经证实了 社会关系对老年人认知的影响；因此，社会支持的中断与 大流行可能会影响老年退伍军人的认知功能。要解决这个问题 可能性，我们提出了一项前瞻性研究，以检验孤立性与精神障碍之间的关系 健康的老年退伍军人和老年退伍军人的流行病和随后的认知功能 阿尔茨海默病(AD)(目标1)。此外，强制隔离很可能不是导致 在大流行中的重要后果。我们建议调查另外两个与大流行有关的 可能会减轻大流行中孤立的影响或加剧 认知损害对老年退伍军人健康相关后果的影响。第一，年纪较大 退伍军人也许能够通过使用建筑环境的特征来应对孤立，例如 门廊、窗景和公共社区空间。然而，建筑环境的范围 是否能够减轻老年人与流行病相关的孤独感尚不清楚。在目标2中，我们测试 建筑环境因素将缓解或促进老年退伍军人社会隔离的假说 使用和不使用AD。此外，个体的认知可能会受到他们对 与社会孤立本身有关的误解。在目标3中，我们检验了认知和认知之间的关系 功能和纠正与社交孤立和AD有关的误解的能力-以及是否 这样的纠正会导致行为的改变。为了实现目标1-3，我们将应用 在第一波大流行期间进行的问卷调查和神经心理测试 (2020年6月至2021年6月)到196名参与者，从10月起再延长三个一年的时间间隔 2022年至2025年9月。在目标1中，我们将测试社会隔离与 一年、两年和三年后的大流行和认知功能。在目标2中，我们将测试年龄更大的 建筑环境资源较少的退伍军人将表现出日益严重的社会孤立， 随着时间的推移，孤独、抑郁、焦虑和认知。在目标3中，将测试两个目标。第一, 我们将确定患有和不患有AD认知障碍的个人可以在多大程度上 成功改变他们对与社会孤立和AD有关的误解的信念 随着时间的推移纠正程序。其次，我们将测试是否与 行为延迟时间间隔为1年和2年。初步的横截面数据来自我们已经 招募了有和没有AD支持的老年人(N=196)的最终样本，他们之间的关系 社会隔离和认知障碍(目标1)、建筑环境和社会隔离(目标2)； 以及认知障碍和错误概念纠正(目标3)。作为大流行的后果 继续发展多年--可能是几十年--我们必须了解这种关系 患有和不患有阿尔茨海默病的退伍军人的社会隔离和未来认知障碍之间的关系 疾病。

The COVID-19 pandemic has caused over half a million deaths in the United States alone. Even for those individuals whose physical health and financial security have not been impacted, the consequences of pandemic-induced isolation on mental and cognitive health may be far-reaching— especially for our Veterans. Prior to the pandemic, approximately 10% of older Veterans reported feeling lonely often and 40% indicated feeling lonely some of the time. Due to social distancing guidelines and other measures that limit social contact, loneliness during the pandemic has likely been far greater than these estimates. Decades of research have supported the protective effect of social relationships on cognition in older adulthood; thus, the disruption of social support related to the pandemic may impact cognitive function in the older Veteran population. To address this possibility, we propose a prospective study to examine the relationships between isolation in the pandemic and subsequent cognitive function in healthy older adult Veterans and in older Veterans with Alzheimer’s disease (AD) (Aim 1). In addition, forced isolation is likely not the only factor with important consequences in the pandemic. We propose investigating two other pandemic-related contexts that may either mitigate the effects of isolation in the pandemic or exacerbate the consequences of cognitive impairment on health-related outcomes for older Veterans. First, older Veterans may be able to cope with isolation through use of features of the built environment, such as porches, window views, and public neighborhood space. However, the extent the built environment may be able to mitigate pandemic-related loneliness in older adults is unknown. In Aim 2, we test the hypothesis that built environment factors will mitigate or contribute to social isolation in older Veterans with and without AD. In addition, individuals’ cognition may be impacted by their belief in misconceptions related to social isolation itself. In Aim 3, we test the relationship between cognitive function and the ability to correct misconceptions related to social isolation and AD—and whether such corrections engender changes in behavior. To accomplish Aims 1-3, we will apply questionnaires and neuropsychological tests administered during the first wave of the pandemic (June 2020-June 2021) to 196 participants over three additional one-year time intervals from October 2022 to September 2025. In Aim 1, we will test the relationship between social isolation in the pandemic and cognitive function one, two, and three years later. In Aim 2, we will test whether older Veterans with fewer built environment resources will demonstrate a worsening of social isolation, loneliness, depression, anxiety, and cognition over time. In Aim 3, two objectives will be tested. First, we will determine the extent that individuals with and without cognitive impairment due to AD can successfully change their belief in misconceptions related to social isolation and AD through a correction procedure over time. Second, we will test whether corrections related to changes in behavior at delayed intervals of 1 and 2 years. Preliminary cross-sectional data from our already recruited final sample of older adults (N=196) with and without AD support the relationships between social isolation and cognitive impairment (Aim 1), the built environment and social isolation (Aim 2), and cognitive impairment and misconception correction (Aim 3). As the ramifications of the pandemic continue to unfold for years—possibly decades—it is imperative that we understand the relationship between social isolation and future cognitive impairment in Veterans with and without Alzheimer’s disease.