Social isolation and social functioning in dementia syndromes: Mechanisms and interventions

Abstract

Social functioning encompasses an individual’s ability to engage in diverse social contexts, from intimate relationships to broader societal settings. Our understanding of the extent to which social functioning is affected across dementia syndromes is limited. Moreover, the social environment has been profoundly reshaped in the wake of the COVID-19 pandemic, including the ramifications of prolonged social isolation.

This thesis aims to uncover the mechanisms underlying social functioning in dementia and develop effective interventions to mitigate social isolation. Pervasive impairments in social functioning across dementia syndromes were revealed, driven in part by apathy and emotion recognition impairment. These findings also demonstrated the adverse effects of social isolation due to pandemic-related restrictions, including worsened neuropsychiatric symptoms in dementia and carer mental health.

In response to these challenges, a tailored carer intervention was developed to enhance carers’ capacity to support people with dementia during COVID-19 lockdowns. This led to improved carer self-efficacy, reduced loneliness and decreased distress related to neuropsychiatric symptoms. Moving beyond the pandemic, social functioning and post-diagnostic care were explored through qualitative methods to co-design a carer program in dementia. This approach revealed a wide spectrum of unmet needs, shedding light on the caregiving experience and the importance of developing person-centred support to address these needs.

Taken together, these studies underscore the critical need for effective post-diagnostic support, both during the pandemic and beyond. These novel findings have important clinical implications for evaluating and managing social functioning impairments in dementia. Importantly, these investigations forge pathways for effective interventions and shape post-diagnostic care that holistically supports people living with dementia and their families.