Bibliographic Reference
Joel Salinas et al. Association of Social Support With Brain Volume and Cognition. JAMA Netw Open, 2021 DOI: 10.1001/jamanetworkopen.2021.21122
At a glance
What is the association between different forms of social support and cognitive resilience? Cognitive resilience is the ability to be less susceptible to changes in brain structure due to aging and disease. Individuals with cognitive resilience have better observed cognitive performance than expected given their brain structure. For instance, smaller brain volumes are generally associated with reduced cognitive function. In this cross-sectional study, researchers examined the modifying effect of different forms of social support on the relationship between brain volume, measured by MRI, and cognitive performance, measured by neuropsychological tests. The results show that high availability of supportive listening is associated with a better global cognitive function than expected for a lower brain volume. This association was absent for other forms of social support. Therefore, to encourage neurocognitive health, promoting specific forms of social support, such as supportive listening, could be justified as a psychosocial intervention and public health strategy.
Background
Cognitive resilience is the difference between an individual’s expected and actual cognitive performance, given their brain structure and level of vulnerability to neuropathological changes. Potential factors for improving cognitive resilience include education, physical and mental activity, and social relationships. Studies suggest that having supportive social networks reduces the risk of Alzheimer’s Disease and Related Disorders (ADRD) by improving cognitive resilience. However, data on the specific mechanisms of social support are scarce. Hence, there is a need to examine the correlation between individual forms of social support, cognitive function, and a global, early neuroanatomical marker of vulnerability to ADRD.
Characteristics of the study
Using a retrospective cross-sectional analysis, researchers used prospective data collected from the Framingham study, a large population-based longitudinal cohort involving 3 generations. This study used data from the original cohort, relating to people enrolled in 1948, and data from the next generation, enrolled in 1971. Participants were included if they were over age 45, didn’t suffer from dementia, stroke, or other neurological conditions, and underwent brain MRI, social support assessment tests, and neuropsychological testing. Specifically, data on total brain volume and the self-rated availability of five different types of social support were used and then measured with the Berkman-Syme Social Network Index. Data were collected from June 6, 1997 to December 13, 1999 (original cohort) and from September 11, 1998 to October 26, 2001 (offspring cohort). Data analysis took place from May 22, 2017 to June 1, 2021. The study included 2,171 adults (164 from the original cohort and 2,007 from the offspring cohort; mean age of 63 years; 54% women).
Results
The primary outcome was a global estimate of cognitive function. Cognitive resilience (β) was defined as the change in the association between total brain volume and cognitive function, such that smaller estimates of the β value indicate greater cognitive resilience (i.e., better cognitive performance than those estimated for lower total brain volume). High listener availability was found to be associated with greater cognitive resilience (β = 0.08, P < .001) than low listener availability (β = 0.20, P = .002). Overall results persisted after adjustment for potential confounding effects. Other forms of social support were not significantly associated (Advice: β = -0.04; P = .40 per interaction; Love-affection: β = -0.07, P = .28 per interaction; Emotional support: β = -0.02, P = .73 per interaction; Sufficient contact: β = -0.08; P = .11 per interaction).
Study Limitations
One possible limitation of this study is that participants were predominantly white adults; however, the overall association of social support with neurocognitive health is generally similar in ethnically diverse cohorts. Furthermore, the results are based on a self-reported assessment of the availability of social support chosen from 5 alternatives, rather than an objective assessment of all social support interactions. Many relevant potential confounders were accounted for in the study. That said, the possibility cannot be ruled out that other confounders capable of influencing overall results were inadvertently overlooked.
What’s New
The results of this study suggest that a specific kind of social support – active listening – is associated with greater cognitive resilience. That is, active listening was found to independently modify the association between minimum values of total brain volume and cognitive function.
Perspectives
The underlying neurobiological mechanisms require further investigation, as they could be useful in preventing cognitive aging. The availability of a good listener, for instance, could contribute to cognitive resilience through neurobiological mechanisms that widely promote experience-induced synaptic plasticity and neurogenesis. A more refined understanding of social support mechanisms has the potential to inform strategies for reducing ADRD risk and improving cognitive resilience. Such an understanding could justify the selection of certain forms of social support, such as active listening, over others in the context of psychosocial interventions and public health strategies that promote neurocognitive health.
