Objective: To investigate how cognition and gait influence social engagement in parkinsonism.

Background: Social engagement is vital to quality of life in parkinsonism, yet the interplay between cognition, gait, and social engagement remains unclear. In particular, their impact on social network size, perceived support, loneliness, and life-space mobility is less defined. This study examines the independent and combined effects of cognition and gait impairment on these four key social engagement facets in parkinsonism^[1-6]..

Method: This cross-sectional study analyzed data from 1360 individuals with parkinsonism from the Rush Alzheimer’s Disease Center database, identified by global parkinsonian summary score, diagnosis status, bradykinesia score, and number of parkinsonian signs. Social engagement measures were network size, perceived support, loneliness (social isolation), and life-space mobility. Multivariate least square regression models estimated standardized coefficients to assess the association between cognition and social engagement measures, after adjusting for demographic and other key clinical covariates.

Results: The correlation heatmap revealed that higher depression was associated with greater loneliness (β = 0.14, p < 0.01)[Fig. 1]. Linear regression showed better cognition linked to greater mobility (β = 0.21, p < 0.01), while lower cognition was linked to increased loneliness (β = -0.15, p < 0.01) [Fig. 2]. Gait impairment was associated with reduced life-space mobility (β = -0.017, p < 0.01) and increased loneliness (β = 0.004, p < 0.01) [Fig. 3].  Multivariate regression models across cognitive quartiles, confirmed that gait impairment’s impact on social engagement was strongest in severe cognitive impairment, with life-space mobility most affected. Preserved cognition mitigated these effects [Fig. 4].

Conclusion: Cognition impacts social engagement and mobility. Our study showed that gait impairment restricted life-space mobility and increases loneliness, with the strongest effects in severe cognitive impairment. Preserved cognition buffered the impact, emphasizing the need for interventions targeting both. The moderate negative correlation between depression and social network size seen in the correlation matrix suggests that depression may contribute to social withdrawal. Future research should examine its role and the longitudinal trajectory of these relationships in shaping social engagement.

Correlation heatmap for predictors in parkinsonism

Effect of cognition on social engagement domains

Effect of Gait on social engagement domains

Effect of gait across cognitive quartiles

References: 1. Prenger MTM, Madray R, Van Hedger K, Anello M, MacDonald PA. Social Symptoms of Parkinson’s Disease. Parkinsons Dis. 2020 Dec 31;2020:8846544. doi: 10.1155/2020/8846544. PMID: 33489081; PMCID: PMC7790585.
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6. González DA, Tosin MHS, Goetz CG. The plight of loneliness in Parkinson’s disease: New opportunities. Parkinsonism Relat Disord. 2022 Dec;105:145-148. doi: 10.1016/j.parkreldis.2022.10.029. Epub 2022 Oct 28. PMID: 36333238.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-cognition-on-social-engagement-in-community-based-older-adults-with-parkinsonism/