Social Dysfunction in Older Age and Relationships with Cognition, Depression, and Apathy: The GreatAGE Study

Article type: Research Article

Authors: Lozupone, Madia^{a; *} | Panza, Francesco^{a; b; c; *} | Piccininni, Marco^{a; b} | Copetti, Massimiliano^d | Sardone, Rodolfo^e | Imbimbo, Bruno P.^f | Stella, Eleonora^g | D’Urso, Francesca^g | Barulli, Maria Rosaria^b | Battista, Petronilla^b | Grasso, Alessandra^b | Tortelli, Rosanna^b | Capozzo, Rosa^b | Coppola, Francesco^e | Abbrescia, Daniela Isabel^e | Bellomo, Antonello^g | Giannelli, Gianluigi^e | Quaranta, Nicola^h | Seripa, Davide^c | Logroscino, Giancarlo^{a; b}

Affiliations: [a] Department of Basic Medical Sciences, Neurodegenerative Disease Unit, University of Bari, Bari, Italy | [b] Department of Clinical Research in Neurology, Unit of Neurodegenerative Diseases, University of Bari “Aldo Moro” at “Pia Fondazione Card. G. Panico”, Tricase, Lecce, Italy | [c] Department of Medical Sciences, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy | [d] Biostatistics Unit, IRCCS-Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy | [e] National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte Bari, Italy | [f] Department of Research and Development, Chiesi Farmaceutici, Parma, Italy | [g] Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy | [h] Otolaryngology Unit, University of Bari Aldo Moro, Bari, Italy

Correspondence: [*] Correspondence to: Francesco Panza, MD, PhD, Department of Basic Medicine, Unit of Neurodegenerative Diseases, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy and Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy. E-mail: [email protected] and Madia Lozupone, MD, PhD, Department of Basic Medicine, Unit of Neurodegenerative Diseases, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy. E-mail: [email protected].

Abstract: Background:Most studies focused on only one measure of social dysfunction in older age, without proper validation and distinction across different dimensions including subjectivity, structural, and functional aspects. Objective:We sought to validate the Social Dysfunction Rating Scale (SDRS) and its factorial structure, also determining the association of SDRS with cognitive functions, global psychopathology, and social deprivation. Methods:The SDRS was administered to 484 Italian community-dwelling elderly, recruited in the GreatAGE study, a population-based study on aging conducted in Castellana Grotte, Bari, Southern Italy. We determined objective and subjective psychometric properties of SDRS against the gold standard evaluation of social dysfunction according to the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID-I) criterion. Results:The SDRS showed a moderate accuracy with an optimal cut-off of 26 maximized with higher sensitivity (0.74,95% CI:0.63–0.84) than specificity (0.57,95% CI:0.50–0.64). A five-factor structure was carried out and five dimensions of SDRS were identified (loneliness; social isolation; feeling of contribution/uselessness; lack of leisure activities; anxiety for the health). Education and global cognitive functions were inversely correlated to SDRS, while a direct association with global psychopathology, depression, and apathy was found. The prevalence of higher SDRS scores was major in subjects with current psychiatric disorders versus other subjects.∥Conclusion: The SDRS could be a valid instrument to capture both size and quality of social dysfunction, both in subjects with psychiatric disorders and in normal subjects. Several categories of social dysfunction differed only in the degree of health deprivation, not in social or material deprivation.

Keywords: Cognitive function, deprivation, lifestyle, loneliness, old age, social dysfunction

DOI: 10.3233/JAD-180466

Journal: Journal of Alzheimer's Disease, vol. 65, no. 3, pp. 989-1000, 2018