Has Your Brain Health Suffered During COVID-19 Isolation?

by Women's Brain Health Initiative:

Staying socially connected is extremely important for our overall health, including our brain health. A 2019 review article published in the Journal of Alzheimer’s Disease found that various aspects of social isolation, including low levels of social activity and poor social networks, are significantly associated with poor cognitive function in later life. The review, which looked at several longitudinal studies, found that a variety of different activities qualified as social, including participating in social groups, visiting family or friends, and engaging in cultural or leisure activities.

In one study published in 2018 in The Journals of Gerontology - Series B, the researchers found that loneliness was associated with a 40% increased risk of developing dementia. The study had a large sample size of over 12,000 participants, and results were adjusted for other contributing factors, such as genetics and behaviour. Additionally, the association was similar across gender, race, ethnicity, education, and genetic risk. In the study, loneliness (i.e. the subjective experience of being alone) was differentiated from social isolation (i.e. a lack of social connections).

Previous research has found that the risk associated with loneliness is independent of the number of social connections and social contact. Even among individuals who have relatively frequent social interactions and are otherwise socially connected, subjective feelings of isolation still increase one’s risk of developing incident dementia.A different study – published in The Journals of Gerontology - Series B in 2019 – used data from the English Longitudinal Study of Aging, which has been tracking the information of British adults biennially since 2002. The researchers found that memory levels decreased as social isolation increased.

Because correlation does not imply causation (in other words, just because two things are occurring simultaneously does not necessarily mean that they are connected), it has been difficult for researchers to determine which comes first – the social isolation or the cognitive impairment.

This study’s key finding suggested that social isolation is what is leading to memory decline, rather than the other way around (namely, poor memory leading individuals to become isolated). Isolation, then, may be one of the instigators of cognitive decline.

Why is social connection so important for our brain health?

“We are fearful of what the consequences are for isolation,” said Dr. Nathanial Chin, Director of Medical Services for the Wisconsin Alzheimer’s Disease Research Center.If people are isolated at home, then they are not engaging with family and friends or participating in other social or leisure activities, and may be more likely to develop loneliness, depression, anxiety, restlessness, and boredom. These conditions are all risk factors for cognitive decline.

Although the science is nascent on this front, we do know that when we are engaged with others, our brains are stimulated. “We’re hitting the language department of our brains. Our attention, our executive function, and the connections between neurons are firing and improving,” said Dr. Chin.

One reason why being social is so important for our brain health could be evolutionary, according to Dr. Michelle C. Carlson, Professor in the Johns Hopkins Bloomberg School of Public Health in the Epidemiology of Aging Division, and one of the issue specialists on the Global Council on Brain Health’s “Brain and Social Connectedness” report published in 2017.“

In order to exist at the group level, to work and to live in civilizations in large numbers like we do, we had to figure out how to cooperate and work together to get our needs met. From an evolutionary standpoint, we figured out early that working together would allow for the likelihood of success and the success of our progeny,” said Dr. Carlson.

Aligning with others, getting needs met, and picking up on nonverbal cues all required (and still require) a significant amount of “brain power.” Humans are built for social connection, Dr. Carlson noted, in both a large-scale sense and on a micro scale (for instance, when a baby ideally bonds with her or his parents, which occurs hormonally through oxytocin).

We continue forging connections throughout the lifespan through friendships, finding a partner, and sometimes having children.

Many of these milestones happen when we are younger, but as the influential developmental psychologist Dr. Erik Erikson has argued, the need to connect does not end in early adulthood. In the later years, age 40 to 65 and beyond, being social is “still related to getting needs met, and related to purpose in life,” said Dr. Carlson.

One study conducted by Dr. Carlson and her colleagues, published in 2015 in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, suggests that being social with a purpose is the most impactful for brain health in one’s older adulthood. For example, her participants involved in Experience Corps – a program where older adults volunteer and share knowledge with underserved elementary school children – halted and in some cases reversed declines in brain regions vulnerable to dementia.

The 2017 “Brain and Social Connectedness” report offers many suggestions for developing and enhancing the quality of your social activities, including maintaining connections with younger people and teaching them a new skill, attending a cooking class, and having a weekly routine of talking to a confidant. Many of the report’s suggestions, though not all, require face-to-face and in-person contact, which is considered optimal.However, the recent COVID-19 restrictions have necessitated physical-distancing measures, especially for older adults who are more vulnerable to infection.

Going to visit friends or loved ones in person has become a genuine health risk and prohibited in certain regions. With restrictions either loosening or tightening depending on the number of cases and location, experts are worried that the already existing epidemic of loneliness has only been exacerbated during the coronavirus pandemic.

At the beginning of the pandemic, the term “social distancing” was widely used, but this phraseology was problematic because it suggested that individuals should not connect with their family and friends whatsoever (irrespective of whether or not they were doing so in safe ways). The term “physical distancing” was later introduced to address this concern, explained Margaret Eaton, National CEO of the Canadian Mental Health Association (CMHA).

“We worry about isolation even for a short while with COVID-19, that it will bring out previously undiagnosed health conditions, be that depression, anxiety, or loneliness. We also worry that it brings out persistent negative thinking. A recent study found that people who have persistent negative thoughts actually had more of the proteins [associated with] Alzheimer’s disease than others,” said Dr. Chin. Therefore, compounding a situation that promotes more negative thinking is particularly worrisome.

Dr. Carlson noted that the enforced isolation of COVID-19 is showing us how important social interaction is – we’re learning how crucial it is to us when we don’t have it.

To date, research studies have not been able to test specifically for not being social. One of the reasons it is so difficult to create randomized, scientific studies around sociality and brain health is that it is unethical to have a group of people who are required to not be social for the purposes of a study. Some researchers are jumping on the in-built example of COVID-19 social isolation for their work, so future studies may yet emerge.

For example, University of Florida neuroscientists are embarking on a new study (led by Dr. Adam J. Woods) to understand the impact of COVID-19 on the cognitive, mental, and brain health of older adults, as well as the impact of social isolation.

New numbers are materializing through a national survey completed by the CMHA and University of British Columbia researchers, which found that 38% of Canadians say that their mental health has deteriorated since COVID-19, 14% are having trouble coping, and more Canadians are thinking about suicide during the pandemic than the previous pre-coronavirus survey. Those with existing mental health problems, Indigenous peoples, individuals with disability, women, low-income individuals, parents with children at home, and other vulnerable groups are particularly struggling.

“People are definitely feeling a lot more stress and anxiety because of having to be indoors,” said Eaton. Particular risk groups include older adults, children, and teenagers.

Families have also felt the pressure, because in addition to the physical-distancing stress, there are the financial and job-related concerns. “For older people or those who live alone, the distancing has been particularly hard, because we’re missing that connection with family and friends, our support groups, the people who make us feel better,” said Eaton, and it is especially problematic if individuals were already dealing with anxiety or depression. Loneliness had already been on the rise before COVID-19, with the decline of organized social groups and a noted “pandemic of loneliness.”

So, what do experts suggest you do to keep socially connected while physically distancing during these challenging times? You have probably already been Zooming, Skyping, and talking on the phone, and that is really important when you cannot go out to social groups or spend time with certain individuals in person. Dr. Chin cautions against relying too heavily on “one-directional” social platforms such as Facebook or Twitter, because they do not offer real-time engagement with another person.

Actually seeing someone on the computer screen in a Zoom or Skype call may even be better than a simple phone call (although that is beneficial as well). “There’s something about seeing and interacting with the other person that is more than the phone, and more than email,” said Dr. Chin, and he is encouraging that kind of interaction as much as possible during physical-distancing measures.

Depending on where you are and what local authorities are encouraging, you might be able to safely do physically distanced meetings with friends and/or family members outside of your bubble. For example, “find a socially acceptable and safe way to walk outdoors together,” recommended Dr. Carlson. While maintaining physical-distancing protocols, it is important for people “to engage socially as much as possible because we know that’s one of the things that creates resilience,” said Eaton. Human beings’ resilience is one of our best qualities as a species, but it does need to be nurtured for it to thrive. At some point, there will be a post-pandemic life, and, until then, help bridge the gap with being as social as possible in safe ways to see you through. Your brain will thank you.

Source: MIND OVER MATTER V11