S3E5. Isolation vs. Engagement

We were out to dinner with two other couples. I wanted to join the conversation, but when the current speaker finished talking, someone else jumped in before me and changed the subject. Having lost the opportunity, I leaned over my bowl of pasta and tried to slurp a mouthful without spraying red sauce all over my white sweater.

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I’ll be the first to admit that social engagement is my weakest suit among the 5 pillars of brain health (exercise, diet, sleep, cognitive challenge, and social engagement). If I weren’t married to Sally and she didn’t schedule us to be with friends and family on a regular basis, I’d probably meet criteria for a hermit or recluse. That’s why I keep an eye out for research that might provide insight into what is an acceptable level of social engagement and what, for that matter, is even considered a social engagement.

In the scene I described at the top of this post, I was out with people, yes, but what if I hadn’t said anything at all the entire evening? Does it count as social engagement if you are with people but don’t talk? Does the mere presence of other people trigger whatever mechanisms are protective against dementia? Or does it require the full deployment of cognitive skills like listening for subtext, being tactful, reading faces, and spinning humor from previously unconnected snippets of conversation? In other words, did I get social engagement credit for my dinner the other night even though I didn’t talk a lot? Would I get credit if I went out by myself and interacted with the waitress? Is that enough to stave off cognitive decline?

I talked about this at length in S1E30: People Who Need People. Recently, though, it seems as if the research effort has shifted from how social engagement is protective to how social isolation is a risk factor. It’s an important difference.

In a study released last month, researchers found a 27% increase in dementia among older Americans who were socially isolated. Social isolation was defined as having few relationships and few people to interact with regularly. The study measured this based on whether or not participants lived alone, talked about “important matters” with two or more people in the past year, attended religious services, or participated in social events. Participants were assigned one point for each answer that reflected social activity, and those who scored a zero or one were classified as socially isolated.

That’s a low bar that I can pass as long as Sally is around! In fact, a 2017 study separated out the effect of being married from other forms of social engagement and found that marriage was protective against dementia but the extent of your social networks was not. The inference was that it might be loneliness that is more determinative than frequency of contacts. 

Interestingly, a separate study showed that talking on the phone and texting reduces social isolation. The Luddite in me has so far resisted the cell phone’s siren song, but in the pursuit of brain health, I just might have to consider taking up texting at some point in the future.

Another study highlighted the advantages of socially engaging with people of different generations. I’m guessing that doing so forces you to assume different roles, with each one stimulating somewhat different brain regions. If this is the case, grandparents who live near their kids have a big built-in advantage.

Isn’t research fascinating? I’m really looking forward to studies that tease apart the unique contributions of loneliness, isolation and social engagement to your risk of developing dementia.

Finally, a recent large-scale study out of China suggests that social engagement is helpful but may not be necessary if you engage in a number of other protective measures.

The researchers focused on six modifiable lifestyle factors (which should all be familiar to regular readers of this blog):

• Physical exercise: Doing at least 150 minutes of moderate or 75 minutes of vigorous activity per week.

• Diet: Eating appropriate daily amounts of at least 7 of 12 food items (fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts and tea).

• Alcohol: Never drinking or drinking occasionally.

• Smoking: Never smoking or being a former smoker.

• Cognitive activity: Exercising the brain at least twice a week (by reading and playing cards or mah-jongg, for example).

• Social contact: Engaging with others at least twice a week (e.g., by attending community meetings or visiting friends or relatives).

It turned out that people living lifestyles that included at least four healthy habits were less likely to progress to mild cognitive impairment and dementia. So it seems it’s possible to protect yourself even without a strong social calendar.

This gives me great hope as I definitely pass muster for at least 5 out of the 6 factors…but I’m still going to try to engage more when Sally schedules me, just in case!

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