Loneliness and Risk of Post-Stroke All-Cause Dementia: A Cohort Study
Y. Chen, M. Li, Y. Ou, Y. Y. LiangIntroduction
Up to 10–30% of stroke survivors develop dementia. Loneliness has been shown to be a psychosocial risk factor for developing stroke and cognitive impairment in the general population. Stroke survivors are more likely to experience loneliness. However, the contribution of loneliness to post-stroke dementia risk remains unclear.
Objectives
We aimed to investigate the association between loneliness and incident dementia in stroke survivors.
Methods
We included 7,267 UK Biobank (No. 93604) participants with prior stroke (mean age =60.5 ±6.9 years, 55.6% male) without baseline dementia. Loneliness was assessed via two self-report questions (frequency of feeling lonely and frequency of confiding in someone close) and defined as a score of 2 (lonely) vs <2 (not lonely). Incident post-stroke dementia (all-cause) was ascertained from hospital records and death registries. We used Cox cause-specific hazards models to estimate hazard ratios (HRs) adjusted for demographics, socioeconomic status, comorbidities, health behaviours and physiological covariates. We also performed a relative importance analysis to rank risk factors. We calculated the Percentage of Excess Risk Mediated (PERM) by grouping explanatory covariates into categories, such as medication, behaviors, and comorbidities.
Results
Over a median 10.2-year follow-up, 290 stroke survivors developed dementia. Loneliness was significantly associated with a higher risk of dementia (fully-adjusted HR 1.67, 95% CI: 1.12–2.49). In a risk-factor ranking, loneliness was the second most important predictor of post-stroke dementia, ranking ahead of conventional factors such as hypertension and obesity. The association between loneliness and post-stroke dementia was magnified in stroke survivors (HR: 1.67, 95% CI: 1.12–2.49) compared to individuals without stroke (HR: 1.22, 95% CI: 1.07–1.39). 25% of the excess dementia risk associated with loneliness was attributable to diabetes-related factors, with the remainder largely explained by medication, behaviors, comorbidities, and other covariates.
Conclusions
Loneliness is an independent risk factor for developing dementia among stroke survivors. This association is partly mediated by modifiable behavioral and physiological pathways. Our findings highlight loneliness as a prominent, yet addressable, risk factor for post-stroke dementia, underscoring the importance of screening for feelings of loneliness in stroke aftercare.
Disclosure of Interest
None Declared