How loneliness may be associated with Parkinson disease

ISLAMABAD, OCT 04 (ONLINE): Researchers report they have found an association between loneliness and Parkinson’s disease.
Their findings were presented in a study Trusted Source published this week in the journal JAMA Neurology.

In their study, the researchers examined more than 491,000 participants with a follow-up period of 15 years.
Researchers said they uncovered the association between loneliness and the risk of Parkinson’s disease independent of depression, genetics, and other prominent risk factors.

In the study, participants were asked, “Do you often feel lonely?” and prompted to answer either “yes” or “no.”
Approximately 18% (91,186 people) indicated they did feel lonely. Those who did report loneliness were slightly younger, more likely to be female, had fewer resources, were less likely to have a college degree, had more health risks – such as smoking and being physically inactive – and had worse overall physical and mental health.

During the 15-year follow-up, 2,822 people in the study developed Parkinson’s disease. The researchers said they used these findings to establish the association between loneliness and Parkinson’s.

How loneliness affects health
The researchers noted that their study adds to growing evidence that loneliness substantially impacts health, including neurodegenerative diseases such as Alzheimer’s disease and other forms of dementia.
“Feelings of loneliness are common in [Parkinson’s] and may result from physical and psychological limitations from the disease,” said Dr. Andrew Feigin, the executive director of The Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Health in New York who was not involved in the study.

“In addition, loneliness can result in depression resulting in withdrawal, lack of motivation, less activity, and potentially less exercise, all behaviors that may negatively impact [Parkinson’s],” he told Medical News Today. “This study suggests that the presence of loneliness may, in fact predate the diagnosis of [Parkinson’s] in some patients and increase the risk of [Parkinson’s}.”

“This study demonstrates an association between loneliness and increased risk of [Parkinson’s} but does not demonstrate cause and effect,” Feigin added. “It is possible that other unknown factors associated with loneliness are what lead to the increased risk of [Parkinson’s] – the authors acknowledge this in the discussion.”

Calculating the risk of Parkinson’s disease
Combating loneliness does not mean reducing the risk of developing Parkinson’s disease.
“This article reports an association between loneliness and the development of Parkinson’s disease,” said Dr. Pietro Mazzoni, a neurologist who specializes in treating Parkinson’s at The Ohio State University Wexner Medical Center who was not involved in the study.
“The study’s major strengths are the very large number of participants (nearly half a million) and that its design was longitudinal: a group of people were followed over 15 years and the number of participants who developed [Parkinson’s] in that time period were counted. These features allow researchers to reach far stronger conclusions than most studies that address this type of question,” Mazzoni told Medical News Today.

“The main finding was that participants who were lonelier at the beginning of the study were more likely to develop [Parkinson’s],” Mazzoni explained. “This finding is very interesting. The conclusion was that there is an increased association between loneliness and a subsequent diagnosis of [Parkinson’s]. It is tempting to extend this conclusion to concern that loneliness might increase the risk of developing [Parkinson’s]. This is absolutely not the case. Although the term ‘risk factor’ is commonly used in the field of epidemiology, its meaning is different from its meaning outside the field of epidemiology.”

“The phrase ‘loneliness increases the risk of developing [Parkinson’s]’ in a medical journal means ‘there is an association between pre-existing loneliness and subsequent being diagnosed with [Parkinson’s]”, i.e. loneliness is a marker that predicts the future development of [Parkinson’s],” he added.

How Parkinson’s slowly develops
According to Mazzoni, there are three things to keep in mind when discussing loneliness and Parkinson’s disease.

1. The study recorded Parkinson’s disease as appearing after the beginning of the study. However, Parkinson’s is thought to start, in the brain, as early as 15 to 20 years before it is diagnosed. Therefore, it is an open question whether loneliness truly preceded Parkinson’s. If loneliness began after the start of brain changes caused by Parkinson’s, then loneliness cannot cause or increase the risk of Parkinson’s.

2. The statistical analysis that is the basis of the study’s conclusion, as well-conceived and as powerful as it is, has an important limitation. The authors accounted for a long list of “covariates”, such as genetic risk factors and physical activity, that could have confounded the results. The method for “accounting for” or “factoring out” these covariates requires assumptions that are difficult to prove. Given how many factors can potentially increase the risk of Parkinson’s, any conclusion that relies on excluding all these factors must be taken with at least some skepticism.

3. Most importantly, as explained above, an association between pre-existing loneliness and Parkinson’s does not mean that reducing loneliness will reduce the risk of developing Parkinson’s in the future. Of course, loneliness is worth combating for many other reasons. In the case of Parkinson’s, the finding of an association is exciting as it suggests that a better understanding of loneliness and its relationship to brain function might provide useful insights into how Parkinson’s begins.
Parkinson’s and the risk of loneliness
Parkinson’s is a movement disorder that can impede getting together with other people.

Someone may need to wait for someone else for transportation. Someone can feel self-conscious because of tremors. Someone might have safety issues.
“Individuals with Parkinson’s have a higher risk of what in the medical field is called apathy, but I don’t believe that is the correct word,” said Dr. Melita Petrossian, a neurologist and director of the Pacific Movement Disorders Center at Pacific Neuroscience Institute in California who was not involved in the study.

“It’s more they lack the motivation to get themselves up and out and talk to other people,” she explained to Medical News Today. “While this is common in people with Parkinson’s, the [COVID-19] pandemic worsened it. There were months when people didn’t leave their houses, and while we could connect digitally, it isn’t the same. But some people may have gotten used to being home alone, which took away even more motivation to get up and out.”

“I see people returning to where they were before the pandemic, but it is a slow process,” Petrossian noted.
“I think it is good for people to have a few people they are very close to, whether family or friend,” she added. “Then there should be another five or six friends. And then they should have a network of acquaintances. I think that would help for people with Parkinson’s not to be lonely.”

Finding friends
“We know with confidence that social relationships play an important role in health and wellbeing across many clinical populations and settings,” said Laura Boxley, PhD, a clinical neuropsychologist in the Department of Psychiatry and Behavioral Health at The Ohio State University Wexner Medical Center who was not involved in the study.

“Modern medical practice now incorporates social determinates of health as an integral framework to better understand risk and plans for care,” she explained to Medical News Today. “Where you live, who you live with, and how you spend your time are all variables that we recognize as having an impact on health behaviors and outcomes.”

The Endeavor Foundation suggests ways of making friends when you have a disability:
Join a club or community group. Check your area for clubs that integrate your interests with socializing. You can use online resources to locate different groups.

Attend a community event. Check your newspaper and online to find events in your area that interest you, such as concerts, craft fairs, cooking demonstrations, or gardening tours. Start by making a list of your interests and then find out what events fit those interests.

Volunteer. There are so many opportunities to volunteer. Do you like animals? Consider volunteering at a local shelter. Do you enjoy spending time with children? Contact your local schools to find out if they have a grandparent program you can join. Do you like being around babies? Many hospitals have volunteer opportunities where you can come and hold and rock infants. You can also look for local charities and nonprofits whose mission fits your personal or career goals.

Enroll in the workshop or adult education course. Is there something you have wanted to learn? A skill you want to improve? Try a Google search for “workshops and classes near me” to see what comes up in your area.

Reconnect with past friends. Social media makes it possible to locate classmates from colleagues whose company you enjoyed decades ago. Once you find them, you only need to say “hi” and see where the conversation goes.
Be open to saying yes. We know it’s easier to say no and stay home. But that choice keeps you alone. Commit to say yes. Maybe start with one yes per month. You might find that once you start getting out there, you enjoy it and will look for more opportunities.