Loneliness and Risk of Parkinson Disease

Abstract

Importance: Loneliness is associated with morbidity and mortality, including higher risk of neurodegenerative diseases. To our knowledge, no study has examined whether the association between loneliness and detrimental outcomes extends to Parkinson disease (PD).

Objective: To assess whether loneliness is associated with risk of incident PD and whether the association is independent of other risk factors or modified by age, sex, and genetic vulnerability.

Design, setting, and participants: This prospective cohort study included a population-based sample of UK Biobank participants aged 38 to 73 years with loneliness data and without a diagnosis of PD at baseline who were first assessed from March 13, 2006, to October 1, 2010, and followed up to October 9, 2021.

Exposure: Feeling lonely and covariates that are known risk factors for or prodromal features of PD.

Main outcome and measure: Incident PD was ascertained through UK National Health Service health records.

Results: Of 491 603 participants (mean [SD] age, 56.54 [8.09] years; 54.4% female), 2822 developed PD during the 15-year follow-up. Individuals who reported being lonely had a higher risk of PD (hazard ratio [HR], 1.37; 95% CI, 1.25-1.51), an association that remained after accounting for demographic factors, socioeconomic status, social isolation, PD polygenetic risk score, smoking, physical activity, body mass index, diabetes, hypertension, stroke, myocardial infarction, depression, and ever seeing a psychiatrist (fully adjusted model: HR 1.25; 95% CI, 1.12-1.39). The association between loneliness and incident PD was not moderated by sex (HR for interaction, 0.98; 95% CI, 95% CI, 0.81-1.18), age (HR for interaction, 0.99; 95% CI, 0.98-1.01), or polygenic risk score (HR for interaction, 0.93; 95% CI, 0.85-1.02). Contrary to expectations for a prodromal syndrome, when stratified by time, loneliness was not associated with risk for incident PD during the first 5 years (HR, 1.15; 95% CI, 0.91-1.45) but was associated with PD risk during the subsequent 10 years (HR, 1.32; 95% CI, 1.19-1.46).

Conclusions and relevance: This large cohort study found that loneliness was associated with risk of incident PD across demographic groups and independent of depression and other prominent risk factors and genetic risk. The findings add to the evidence that loneliness is a substantial psychosocial determinant of health.

Figure 1.. Cumulative Hazard of Parkinson Disease Among Participants Who Did and Did Not Report Loneliness at Baseline, Adjusted for Age and Sex.

Figure 2.. Association of Loneliness With Incident Parkinson Disease (PD) in Models With Different Sets of Covariates and the Fully Adjusted Model

Numbers of total participants and participants with PD vary across models because of missing data for the covariates. The percentage of excess risk mediated (PERM) represents the level of attenuation of other models compared with the basic model (model 1). Age and sex were included as covariates in all models. Markers indicate hazard ratios (HRs), with horizontal lines representing 95% CIs.