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American Journal of Epidemiology Advance Access originally published online on January 12, 2006
American Journal of Epidemiology 2006 163(5):433-440; doi:10.1093/aje/kwj061
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

The Effect of Social Engagement on Incident Dementia

The Honolulu-Asia Aging Study

Jane S. Saczynski1, Lisa A. Pfeifer1, Kamal Masaki2,3, Esther S. C. Korf4, Danielle Laurin1, Lon White2,3 and Lenore J. Launer1

1 Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD
2 Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
3 Pacific Health Research Institute, Honolulu, HI
4 Department of Neurology and Alzheimer Center, Vrije University Medical Center, Amsterdam, the Netherlands

Correspondence to Dr. Jane S. Saczynski, Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, 7201 Wisconsin Avenue, Gateway Building, Room 3C-309, Bethesda, MD 20892-9205 (e-mail: saczynsj{at}mail.nih.gov).

The authors examined whether low levels of social engagement in midlife and late life were associated with the risk of incident dementia in 2,513 Japanese-American men who have been followed since 1965 as part of the Honolulu Heart Program and the Honolulu-Asia Aging Study. In 1991, assessment of dementia began; incident dementia cases (n = 222) were diagnosed in 1994 and 1997. Social engagement was assessed in midlife (1968) and late life (1991). The relation between social engagement and dementia risk was examined using Cox proportional hazards models. No level of midlife social engagement was associated with the risk of dementia. In late life, compared with participants in the highest quartile of late-life social engagement, those in the lowest quartile had a significantly increased risk of dementia (hazard ratio = 2.34, 95% confidence interval: 1.18, 4.65). However, compared with those who were in the highest quartile of social engagement at both midlife and late life, only decreased social engagement from midlife to late life was associated with an increased risk of dementia (hazard ratio = 1.87, 95% confidence interval: 1.12, 3.13). Although low social engagement in late life is associated with risk of dementia, levels of late-life social engagement may already have been modified by the dementing process and may be associated with prodromal dementia.

aging; Alzheimer disease; dementia; interpersonal relations; social behavior; social isolation

Abbreviations: APOE, apolipoprotein E; CASI, Cognitive Abilities Screening Instrument


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