Wang Jinqi, Jiao Danyang, Zhao Xiaoyu, Tian Yixing, Li Haibin, Li Xia, Sheng Chen, Tao Lixin, Chen Hui, Wu Zhiyuan, Guo Xiuhua
Beijing Key Laboratory of Environment and Aging, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
JAMA Netw Open. 2025 Sep 2;8(9):e2531493. doi: 10.1001/jamanetworkopen.2025.31493.
Adult loneliness has been linked to cognitive decline and dementia risk, but the long-term implications of childhood loneliness remain underexplored.
To investigate whether childhood loneliness is associated with cognitive decline and dementia risk and whether adult loneliness mediates or modifies these associations.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the China Health and Retirement Longitudinal Study, a nationally representative cohort study conducted between June 1, 2011, and December 31, 2018, with a maximum follow-up of 7 years. Data analyses were performed from October 1, 2024, to January 15, 2025.
Childhood loneliness was defined as self-reported frequent feelings of loneliness and the absence of close friendships before age 17 years. Adult loneliness was measured by a single item from the Centre for Epidemiological Studies Depression Scale.
Cognitive function was assessed through measures of episodic memory and executive function. Dementia was identified as the coexistence of cognitive and functional impairments or a self- or caregiver-reported physician diagnosis of dementia. Associations between childhood loneliness and cognitive decline were evaluated using linear mixed-effects models, and dementia risk was analyzed using Cox proportional hazards regression models.
Among 13 592 participants (mean [SD] age, 58.34 [9.39] years; 7175 [52.8%] female), 6525 (48.0%) experienced possible childhood loneliness, and 565 (4.2%) reported childhood loneliness. Compared with no childhood loneliness, childhood loneliness was associated with significantly faster cognitive decline (β, -0.03 [95% CI, -0.05 to -0.02] SD per year), as was possible childhood loneliness (β, -0.02 [95% CI, -0.02 to -0.01] SD per year). Moreover, childhood loneliness was associated with an increased risk of dementia (hazard ratio, 1.41 [95% CI, 1.03 to 1.93]). These associations remained significant when adjusted for adult loneliness and restricted to participants without adult loneliness. Adult loneliness mediated 8.5% (95% CI, 2.9% to 14.1%) of the association of childhood loneliness with cognitive decline and 17.2% (95% CI, 4.9%-29.5%) of the association with dementia risk but did not significantly modify these associations.
In this cohort study, childhood loneliness was associated with cognitive decline and dementia risk in middle and later adulthood, even in the absence of adult loneliness. Early interventions aimed at reducing childhood loneliness may help promote lifelong cognitive health and reducing dementia risk.
成人孤独感已被证明与认知能力下降和患痴呆症风险有关，但童年孤独感的长期影响仍未得到充分研究。
调查童年孤独感是否与认知能力下降和患痴呆症风险相关，以及成人孤独感是否介导或改变这些关联。
设计、地点和参与者：这项队列研究使用了中国健康与养老追踪调查（China Health and Retirement Longitudinal Study）的数据，这是一项具有全国代表性的队列研究，于2011年6月1日至2018年12月31日进行，最长随访7年。数据分析于2024年10月1日至2025年1月15日进行。
童年孤独感被定义为自我报告的频繁孤独感以及17岁之前没有亲密友谊。成人孤独感通过流行病学研究中心抑郁量表（Centre for Epidemiological Studies Depression Scale）中的一个单项进行测量。
通过情景记忆和执行功能测量来评估认知功能。痴呆症被定义为认知和功能障碍并存，或自我或照顾者报告的医生诊断为痴呆症。使用线性混合效应模型评估童年孤独感与认知能力下降之间的关联，并使用Cox比例风险回归模型分析患痴呆症风险。
在13592名参与者中（平均[标准差]年龄为58.34[9.39]岁；7175名[52.8%]为女性），6525名（48.0%）经历过可能的童年孤独感，565名（4.2%）报告有童年孤独感。与没有童年孤独感相比，童年孤独感与认知能力下降显著更快相关（β，-0.03[95%置信区间，-0.05至-0.02]标准差/年），可能的童年孤独感也是如此（β，-0.02[95%置信区间，-0.02至-本内容由豆包提供，-0.01]标准差/年）。此外，童年孤独感与患痴呆症风险增加相关（风险比，1.41[95%置信区间，1.03至1.93]）。在对成人孤独感进行调整并仅限于没有成人孤独感的参与者时，这些关联仍然显著。成人孤独感介导了童年孤独感与认知能力下降关联的8.5%（95%置信区间，2.9%至14.1%）以及与患痴呆症风险关联的17.2%（95%置信区间，4.9%-29.5%），但并未显著改变这些关联。
在这项队列研究中，童年孤独感与中老年期的认知能力下降和患痴呆症风险相关，即使在没有成人孤独感的情况下也是如此。旨在减少童年孤独感的早期干预措施可能有助于促进终身认知健康并降低患痴呆症风险。
