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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S93-S100 (2003)
© 2003 The Gerontological Society of America


Social Networks, Social Integration, and Social Engagement Determine Cognitive Decline in Community-Dwelling Spanish Older Adults

María-Victoria Zunzunegui1,, Beatriz E. Alvarado1, Teodoro Del Ser2 and Angel Otero3

1 Département de Médecine Sociale et Préventive, Université de Montréal, Quebec, Canada.
2 Sección de Neurología, Hospital Severo Ochoa, Leganés, Madrid, Spain.
3 Centro Universitario de Salud Pública, Universidad Autónoma de Madrid, Spain.

Address correspondence to María-Victoria Zunzunegui, Départment de Médecine Sociale et Préventive, Faculté de Médecine, Université de Montréal, CP 6128, Succ Centre Ville, Montréal, Québec H3C 3J7, Canada. E-mail: maria.victoria.zunzunegui{at}

Objectives. To examine the influence of social networks and social engagement on cognitive decline in a population-based cohort of elderly people, and to assess gender differences in the effect of social relations on cognition.

Methods. A longitudinal study of community-dwelling people over 65 was carried out. Cognitive function (orientation and memory) in 1997 and cognitive decline (absent, mild, and severe) over 4 years (1993–1997) were assessed using an instrument previously validated for populations with a low level of education. The effect of social networks, social integration, and social engagement with friends, children, and relatives on cognitive function and cognitive decline was estimated by multiple linear and logistic regressions after adjusting for age, sex, education, depressive symptoms, systolic and diastolic blood pressure, and functional status.

Results. Poor social connections, infrequent participation in social activities, and social disengagement predict the risk of cognitive decline in elderly individuals. The probability of cognitive decline was lower for both men and women with a high frequency of visual contact with relatives and community social integration. Engagement with friends seemed to be protective for cognitive decline in women but not in men.

Discussion. This longitudinal study indicates that few social ties, poor integration, and social disengagement are risk factors for cognitive decline among community-dwelling elderly persons. The nature of the ties that influence cognition may vary in men and women.

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