Skip to main content Accessibility help

Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults

Published online by Cambridge University Press:  14 November 2018

Ada W. T. Fung
Department of Applied Social Sciences, The Polytechnic University of Hong Kong, Hong Kong SAR, China
Allen T. C. Lee
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
S.-T. Cheng
Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
Linda C. W. Lam
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
E-mail address:



Loneliness and social networks have been extensively studied in relation to cognitive impairments, but how they interact with each other in relation to cognition is still unclear. This study aimed at exploring the interaction of loneliness and various types of social networks in relation to cognition in older adults.


a cross-sectional study.


face-to-face interview.


497 older adults with normal global cognition were interviewed.


Loneliness was assessed with Chinese 6-item De Jong Gierverg’s Loneliness Scale. Confiding network was defined as people who could share inner feelings with, whereas non-confiding network was computed by subtracting the confiding network from the total network size. Cognitive performance was expressed as a global composite z-score of Cantonese version of mini mental state examination (CMMSE), Categorical verbal fluency test (CVFT) and delayed recall. Linear regression was used to test the main effects of loneliness and the size of various networks, and their interaction on cognitive performance with the adjustment of sociodemographic, physical and psychological confounders.


Significant interaction was found between loneliness and non-confiding network on cognitive performance (B = .002, β = .092, t = 2.099, p = .036). Further analysis showed a significant interaction between loneliness and the number of family members in non-confiding network on cognition (B = .021, β = .119, t = 2.775, p = .006).


Results suggested that a non-confiding relationship with family members might put lonely older adults at risk of cognitive impairment. Our study might have implications on designing psychosocial intervention for those who are vulnerable to loneliness as an early prevention of neurocognitive impairments.

Original Research Article
© International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below.


Bassuk, S. S., Glass, T. A. and Berkman, L. F. (1999). Social disengagement and incident cognitive decline in community-dwelling elderly persons. Annals of Internal Medicine, 131, 165173. doi: 10.7326/0003-4819-131-3-199908030-00002.CrossRefGoogle ScholarPubMed
Bennett, D. A., Schneider, J. A., Tang, Y., Arnold, S. E. and 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. Lancet Neurology, 5, 406412. doi: 10.1016/S1474-4422(06)70417-3.CrossRefGoogle ScholarPubMed
Bickel, H. and Cooper, B. (1994). Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study. Psychological Medicine, 24, 179192. doi: 10.1017/S0033291700026945.CrossRefGoogle Scholar
Chiu, H. F. et al. (1997). The modified fuld verbal fluency test: a validation study in Hong Kong. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 52, P247P250. doi: 10.1093/geronb/52B.5.P247.CrossRefGoogle ScholarPubMed
Chiu, H. F., Lee, H., Chung, W. and Kwong, P. (1994). Reliability and validity of the Cantonese version of mini-mental state examination—A preliminary study. Journal of Hong Kong College of Psychiatry, 4, 2528.Google Scholar
Crooks, V. C., Lubben, J., Petitti, D. B., Little, D. and Chiu, V. (2008). Social network, cognitive function, and dementia incidence among elderly women. American Journal of Public Health, 98, 12211227. doi: 10.2105/AJPH.2007.115923.CrossRefGoogle ScholarPubMed
Donovan, N. J. et al. (2016). Association of Higher Cortical Amyloid Burden With Loneliness in Cognitively Normal Older Adults. JAMA Psychiatry, 73, 12301237. doi: 10.1001/jamapsychiatry.2016.2657.CrossRefGoogle ScholarPubMed
Fratiglioni, L., Wang, H. X., Ericsson, K., Maytan, M. and Winblad, B. (2000). Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet, 355, 13151319. doi: 10.1016/S0140-6736(00)02113-9.CrossRefGoogle ScholarPubMed
Goldberg, L. R. (1992). The development of markers for the big five factor structure. Psychological Assessment, 4, 2642. doi: 10.1037/1040-3590.4.1.26.CrossRefGoogle Scholar
Goldberg, L. R. et al. (2006). The international personality item pool and the future of public-domain personality measures. Journal of Research in Personality, 40, 8496. doi: 10.1016/j.jrp.2005.08.007.CrossRefGoogle Scholar
Håkansson, K. et al. (2009). Association between mid-life marital status and cognitive function in later life: population based cohort study. BMJ, 339, b2462. doi: 10.1136/bmj.b2462.CrossRefGoogle ScholarPubMed
Holwerda, T. J. et al. (2014). Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL). Journal of Neurology, Neurosurgery, and Psychiatry, 85, 135142. doi: 10.1136/jnnp-2012-302755.CrossRefGoogle Scholar
Lam, L. C. et al. (2008). Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. International Psychogeriatric, 20, 135–48. doi: 10.1017/S1041610207006199.CrossRefGoogle ScholarPubMed
Leung, G. T., De Jong Gierveld, J. and Lam, L. C. (2008). Validation of the Chinese translation of the 6-item De Jong Gierveld Loneliness Scale in elderly Chinese. International Psychogeriatric, 20, 12621272. doi: 10.1017/S1041610208007552.CrossRefGoogle ScholarPubMed
Lewis, G., Pelosi, A. J., Araya, R. and Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine, 22, 465486. doi: 10.1017/S0033291700030415.CrossRefGoogle ScholarPubMed
Luo, Y. and Waite, L. J. (2014). Loneliness and mortality among older adults in China. The Journals of Gerontology: Series B, 69, 633645. doi: 10.1093/geronb/gbu007.CrossRefGoogle Scholar
Mchugh, J. E., Kenny, R. A., Lawlor, B. A., Steptoe, A. and Kee, F. (2016). The discrepancy between social isolation and loneliness as a clinically meaningful metric: findings from the Irish and English longitudinal studies of ageing (TILDA and ELSA). International Journal of Geriatric Psychiatry, 32, 664674. doi: 10.1002/gps.4509.CrossRefGoogle Scholar
Morris, J. C. (1997). Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatric, 9 (Suppl 1), 173176; discussion 177–178. doi: 10.1017/S1041610297004870.CrossRefGoogle ScholarPubMed
Parmelee, P. A., Thuras, P. D., Katz, I. R. and Lawton, M. P. (1995). Validation of the Cumulative Illness Rating Scale in a geriatric residential population. Journal of the American Geriatrics Society, 43, 130137. doi: 10.1111/j.1532-5415.1995.tb06377.x.CrossRefGoogle Scholar
Perlman, D. and Peplau, L. (1981). Toward a social psychology of loneliness. In: Gilmour, R. and Duck, S. (eds.), Personal Relationships 3: Personal Relationships in Disorder. London: Academic Press.Google Scholar
Pillai, J. A. and Verghese, J. (2009). Social networks and their role in preventing dementia. Indian Journal of Psychiatry, 51 (Supp 1), 2228.Google ScholarPubMed
Saczynski, J. S. et al. (2006). The effect of social engagement on incident dementia: the Honolulu-Asia Aging Study. American Journal of Epidemiology, 163, 433440. doi: 10.1093/aje/kwj061.CrossRefGoogle ScholarPubMed
Savikko, N., Routasalo, P., Tilvis, R. S., Strandberg, T. E. and Pitkala, K. H. (2005). Predictors and subjective causes of loneliness in an aged population. Archives of Gerontology and Geriatrics, 41, 223233. doi: 10.1016/j.archger.2005.03.002.CrossRefGoogle Scholar
Seeman, T. E., Lusignolo, T. M., Albert, M. and 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, 243255. doi: 10.1037/0278-6133.20.4.243.CrossRefGoogle ScholarPubMed
Shankar, A., Hamer, M., Mcmunn, A. and 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, 161170. doi: 10.1097/PSY.0b013e31827f09cd.CrossRefGoogle ScholarPubMed
Steptoe, A., Shankar, A., Demakakos, P. and Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America, 110, 57975801. doi: 10.1073/pnas.1219686110.CrossRefGoogle ScholarPubMed
Tilvis, R. S., Kahonen-Vare, M. H., Jolkkonen, J., Valvanne, J., Pitkala, K. H. and Strandberg, T. E. (2004). Predictors of cognitive decline and mortality of aged people over a 10-year period. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59, M268M274. doi: 10.1093/gerona/59.3.M268.CrossRefGoogle Scholar
Wilson, R. S. et al. (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry, 64, 234–40. doi: 10.1001/archpsyc.64.2.234.CrossRefGoogle ScholarPubMed
Wong, C., Leung, G., Fung, A., Chan, W. and Lam, L. (2013). Cognitive predictors for five-year conversion to dementia in community-dwelling Chinese older adults. International Psychogeriatrics, 25, 11251134. doi: 10.1017/S1041610213000161.CrossRefGoogle ScholarPubMed
Yang, K. and Victor, C. R. (2008). The prevalence of and risk factors for loneliness among older people in China. Ageing and Society, 28, 305327. doi: 10.1017/S0144686X07006848.CrossRefGoogle Scholar
Yeh, S.-C. J. and Liu, Y.-Y. (2003). Influence of social support on cognitive function in the elderly. BMC Health Services Research, 3, 9. doi: 10.1186/1472-6963-3-9.CrossRefGoogle ScholarPubMed
Yoshitake, T. et al. (1995). Incidence and risk factors of vascular dementia and Alzheimer’s disease in a defined elderly Japanese population: the Hisayama Study. Neurology, 45, 11611168. doi: 10.1212/WNL.45.6.1161.CrossRefGoogle Scholar
Yu, J., Lam, C. L. and Lee, T. M. (2016). Perceived loneliness among older adults with mild cognitive impairment. International Psychogeriatrics, 28, 16811685. doi: 10.1017/S1041610216000430.CrossRefGoogle ScholarPubMed
Zhong, B. L., Chen, S. L., Tu, X. and Conwell, Y. (2017). Loneliness and cognitive function in older adults: Findings from the Chinese longitudinal healthy longevity survey. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 72, 120128. doi: 10.1093/geronb/gbw037.CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 25
Total number of PDF views: 199 *
View data table for this chart

* Views captured on Cambridge Core between 14th November 2018 - 16th January 2021. This data will be updated every 24 hours.

Hostname: page-component-77fc7d77f9-wd6lz Total loading time: 0.599 Render date: 2021-01-16T05:59:15.441Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags last update: Sat Jan 16 2021 05:51:00 GMT+0000 (Coordinated Universal Time) Feature Flags: { "metrics": true, "metricsAbstractViews": false, "peerReview": true, "crossMark": true, "comments": true, "relatedCommentaries": true, "subject": true, "clr": true, "languageSwitch": true, "figures": false, "newCiteModal": false, "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true }

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *