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Associations of Social Supports and Cognitive Functions

Kay Thwe Kyaw, DrPH,M.B.,B.S,MPH ¹

1: Founder of kaytharalotus LLC

Associations of Social Supports and Cognitive Functions © 2026 by Kay Thwe Kyaw is licensed under Creative Commons Attribution-NoDerivatives 4.0 International. To view a copy of this license, visit https://creativecommons.org/licenses/by-nd/4.0/

Abstract

Background: With increasing older adults with Alzheimer’s disease and related disorders, maintaining cognitive function with high quality of life through different social supports (telecommunication, emotional, informational, social, physical, financial) is one of the public health implications. This study examined whether better social support might be associated with better cognitive performance in rural South Africa.

Method: This study, a cross-sectional study, included 541 participants in the HAALSI Dementia Cohort (Health and Aging in Africa: Longitudinal Study of an INDEPTH Community in South Africa). Exposures were types of social supports: telecommunication, emotional, physical, information, and financial. The outcome measure was cognitive function assessed by standardized neuropsychological assessments and z-score of global cognitive function. Covariates included age, gender, education, depression, and vascular risk factors. Multiple robust regression with (S-efficiency) analysis was conducted.

Results: Greater telecommunication social support was associated with better global cognitive function after adjustment for age, gender, education, depression, and vascular risk factors (β = 0.0167, 95% CI 0.0087, 0.0248); emotional social support was similarly associated after adjustment for age, gender, education, and depression (β = 0.0083, 95% CI 0.0001, 0.0164).

Conclusion: The telecommunication and emotional social support were associated with better cognitive performance in a rural South African cohort. This research findings may help guide public health policy aimed at reducing cognitive decline, and inform prospective studies aimed at further understanding the complex mechanistic pathways between social support and cognitive function.

Keywords: telecommunication social supports, emotional social supports, cognitive function, healthy aging, quality of life

1.Background

The population of adults aged 60 or older is projected to increase from approximately 1 billion in 2019 to 1.4 billion in 2030.¹ As the number of older adults increases, the prevalence of age-associated diseases, including Alzheimer’s disease and related disorders (ADRD), will also increase.² The various stress from socioeconomic disadvantages (emotional, financial, social contact, and physical) secretes cortisol from the hypothalamic-pituitary axis (HPA), and hence impair cognitive function in the same regulatory area of the temporal lobe.³ Therefore, identifying modifiable risk factors, social supports, for ADRD and elucidating their underlying neuropsychological processes may be a practical, cost-effective approach to maintain the quality of life. ^{4, 5} Bidirectional association of modifiable risk factors could explains by the concept that having extensive social contacts and social supports (telecommunications, informational, emotional, physical, financial) could provide substantial resources, and hence give rise to emotional drains from getting misinformation or incompatibility of supports receiving with subsequent strains of stress on HPA, and subsequent decline in cognitive function while balance of those provide better cognitive function. ^{2, 6-8} Social contact, defined in a different context, is explained as the mode, number, and type of connection among individuals, families, and communities. ^{9, 10} Social networks are understood as types of exchange or interaction with person-to-person connectivity. ⁷ Social supports, defined as a social phenomenon, are the process by which people help one another, particularly in distressing times; verbal and non-verbal behaviors that are intended to help. ⁷ Three major categories of social support are emotional support (the act of showing empathy, care, and concern for others), informational support (the act of advising to assist with problem-solving), and tangible support (the act of providing concrete ways to help, whether physical or financial). ⁷ Furthermore, face-to-face communication is not always feasible; thus, support provided via telecommunication (e.g., telephone, email, text messaging, and social networking websites) provides emotional and informational support. ⁷ Previous studies found that social support, including emotional support, is associated with better cognitive health and reduces the risk of dementia, although most did not provide a comprehensive understanding of variation across countries and lacked generalizability to diverse populations. ^11-19 The incidence of dementia and levels of social support differ across racial groups, regions, and cultures. Research is needed to assess the effects of different types of social support on cognitive function in diverse populations. ²⁰ This study investigated the hypotheses that better telecommunication, emotional, physical, information, and financial social supports would be associated with better global cognitive function as primary outcomes, and cognitive domains as secondary outcomes.

2. Methods

2.1 Study Design and Sample

This cross-sectional study included 541 participants from the Health and Aging in Africa: Longitudinal Studies in South Africa (HAALSI) Dementia Cohort. ²¹ The inclusion criteria were: no diagnosis of dementia, age 49 years or older during the study period (2019–2020), and availability of information on cognitive function and social support. The exclusions were participants having a history of stroke, a history of traumatic brain injury, and participants who did not complete the neurological examination, to avoid internal validity of the study. (Figure 1.) Participants with a history of stroke are more likely to have vascular dementia, while those with a history of traumatic brain injury are more likely to have memory impairment, which is known as a confounding factor in the occurrence of dementia. ^{22, 23} Institutional review board approval was not required, as this study used de-identified secondary data. ²¹

2.1.1 Exposure

Participants’ exposure to telecommunication-based social support, emotional support, physical social support, informational social support, and financial social support was measured with the survey questions. Telecommunication social support is measured by survey questions “Which of the following answers best describes how often you typically interacted with [on the phone] by SMS, through email, or the internet over the past six months, and the number of social contacts?”; physical social support is measured by survey questions “Which of the following answers best describes how often you typically received physical support, such as when you needed help with chores around the house or at work, taking care of yourself or going from one place to another, over the past 6 months?”; emotional social support is measured by survey questions Which of the following answers best describes how often you typically received emotional support, such as when you are feeling sad or anxious or upset, over the past six months, and the number of social contacts?”; financial social support is measured by survey questions “Which of the following answers best describes how often you typically received financial social support from, such as borrowing money, receiving food, being given a job or anything related to money or in-kind transfer, over the past 6 months?”; informational social support is measured by survey questions “Which of the following answers best describes how often you typically received informational support, such as receiving advice about important health issues, employment issues, or any other important matters, over the past 6 months?”.  Answers to the mentioned survey questions regarding telecommunication, emotional, physical, information, and financial social support were scored on a scale from 1 to 7, with “7” indicating every day or almost every day, “6” indicating a few times per week, “5” indicating once per week, “4” indicating a few times per month, “3” indicating once per month, “2” indicating a few times in the past 6 months, and “1” indicating not at all. ^{15, 21, 24} In this score, the higher the score, the better the social support.

2.1.2 Outcomes

The primary outcome measure was global cognitive function, which includes domains of cognitive functions (DOCF), measured with a neuropsychological battery validated in this population that assesses domains consistent with the Alzheimer’s Disease Research Centers Uniform Data Set. The secondary outcomes, DOCF, are Mini-Mental State Exam (MMSE) and Telephone Interview Cognitive Status (TICS), episodic memory domains (immediate, delayed, recognition), Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word recall (immediate, delayed, and recognition), verbal memory domains (Boston naming: phonemic cue, semantic cue, and semantic fluency correct animal named), Go/No-Go, visuospatial constructional domain (spatial forward, spatial reverse, constructional praxis total, and recalled), similarities and differences, symbol cancellation, reading test (digits, letters, words, and reading grades), days of the week, motor sequencing, token test, and Raven matrices. ²¹

2.1.3 Covariates

Covariates included age, gender, education, depression, and vascular risk factors. Education was assessed with a four-level variable (no education, preschool to grade 7, grade 8 to grade 11, and at least partial tertiary education). ²¹ Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) scale, with loneliness excluded to avoid measurement bias. ²¹ Vascular risk factors were hypertension or diabetes mellitus.

2.2 Statistical Analysis

A priori power analysis showed that the sample required for the expected small effect size (0.20) for the association between social support and cognitive function was 88 participants to achieve 90% power. ^{15, 24} Global cognitive function was constructed by DOCF. Z-scores for DOCF and global cognitive function were calculated. In view of a non-monotone missing pattern, hot deck imputation with simple random selection replacement for covariates, baseline age, and vascular risk factors was applied for missingness as it better explains the variability of imputed scores than simple mean substitution and regression-based analysis, and requires fewer distributional assumptions.²⁵  The S-efficacy method robust regression models with or without adjustments, and it performs better because it estimates residual errors from the regression lines, corrects the residual errors and variance, determines the sum of squares error, and adjusts residuals close to the regression line, due to non-normal distribution. ²⁶ The models with each social support were fit separately.

Principal component analysis (PCA) was performed to construct a global cognitive function metric, using the criterion of eigenvalues > 1. The interaction between the association of global cognitive functions and social supports was assessed with demographic factors: age (< 70 and ≥ 70 years), gender (men and women), and educational level (no education and at least some education). Statistical significance for interaction was determined with an exploratory significance level of p < 0.10. ²⁷All other analyses used a significance level of p < 0.05, and were performed in Statistical Analysis Software (SAS), version 9.4.

3. Results

3.1 Descriptive Analysis

The average age of the 541 participants in the 2019–2020 HAALSI Dementia cohort who met the inclusion criteria was 71 ± 11 years, and most participants were women (64.7% women; 35.3% men). Most participants reported no education (54.2%), and the remaining participants had varying highest educational levels, including preschool to grade 7 (34.6%), grades 8–11 (6.4%), and at least partial tertiary education (4.8%). Most participants had some vascular risk factors (62.1%), whereas 37.9% did not. The mean depression score, measured with the modified CES-D, was 12.8 ± 9.1 (Table 1). Six factors of PCA were extracted for 26 cognitive domains with orthogonal loading and varimax, and eigenvalue of the first principal component: 9.41 with a variance 55 %.

3.2 S-efficiency Multiple Robust Regression Analyses

Robust regression model 3, adjusted for age, gender, educational level, depression, and vascular risk, was determined to be the best-fit model based on the largest R^{2 value}.

3.2.1 Telecommunication social support (TSS)

The “1” point higher TSS was significantly associated with 0.0172 higher z-scores of global cognitive functions after adjustment for age, gender, and education (β = 0.0172, 95% CI: 0.009, 0.0253). A higher TSS was associated with better MMSE, Go/No-Go, spatial forward; reading test (digits), logical memory (immediate), logical memory (delayed), telephone interview cognitive status, CERAD word recall (delayed and immediate), and motor sequencing test results (Table 2). The “1” point higher TSS was significantly associated with 0.0193 higher z-scores of MMSE (β = 0.0193, 95% CI: 0.0116, 0.0269),  0.0114 higher z-scores of measured Go/No-Go (β = 0.0114, 95% CI: 0.0026, 0.0203) after adjustment for age, gender, and education. The “1” point higher TSS was associated with a higher z score for spatial forward and constructional praxis, which totally explains the clinical benefits of improving mobility and healthy aging, and prevents falls, improving dexterity, and improving functional abilities. (Table 2).

3.2.2 Emotional Social Support (ESS)

The “1” point higher ESS score was significantly associated with 0.0092 higher z-scores of global cognitive functions after adjustment for age, gender, and education, (β = 0.0092, 95% CI: 0.0010–0.0174) and better cognitive functions domains measured by the reading test (digits, words, and reading grade) and the logical memory delayed test (Table 2).

3.2.3 Physical social support (PSS)

The “1” point higher level of PSS was associated with higher z-scores of cognitive functions, measured by reading grade, similarities, and differences, although it was not significantly associated with global cognitive function. (Table 2.)

3.2.4 Informational social support (ISS)

This study did not find any association between ISS and cognitive functions.

3.2.5 Financial social support (FSS)

The “1” point higher level of FSS was not associated with global cognitive function, while it was associated with higher z-scores of cognitive functions measured by reading letters, similarities, and differences. (Table 2.)

3.3 Interaction assessment

There were no significant interactions by age (< 70 and ≥ 70 years) and gender (men and women) for the association between cognitive functions and global cognitive functions and TSS, ESS, PSS, ISS, and FSS. Interestingly, educational level (no education and at least some education) modified the associations between telecommunication social support and cognitive function measured by spatial reverse, logical memory (immediate) cognitive function scores, and global cognitive functions. Compared with the no education group in all three models, the “1” point higher level of TSS was associated with higher z-scores of cognitive functions measured by spatial forward, spatial reverse, telephone interview cognitive status, CERAD word recall delayed and recognition, token test, logical memory (immediate), and logical memory (delayed) cognitive function in the education group. However, the “1” point higher level of TSS was associated with higher z-scores of cognitive functions, as measured by the cognitive domain Go/No-Go, in the no-education group. (Figure 3.)

4. Discussions

In this cross-sectional study, a higher frequency of social support received in the prior 6 months, in the form of TSS or ESS, was associated with better global cognitive function. In addition, a higher frequency of receiving TSS was associated with better functioning in several cognitive domains, including executive function, visuospatial constructional praxis function, and episodic memory (immediate and delayed) in the 2019–2020 HAALSI cohort. Moreover, education modified the association between TSS and the domains of executive, visuospatial constructional praxis, and episodic memory. This research did not identify an association between ISS and any cognitive function measures, nor did it. In a previous cross-sectional study in HAALSI cohort, participants with lower cognitive function (as measured by orientation in time, episodic memory, and ability to count forward from one to 20 and complete a number pattern) had smaller, denser social networks; thus, lower cognitive function was associated with less total social support, as measured by participants’ levels of emotional, financial, physical, and informational support. ¹⁵ Furthermore, participants were more likely to demonstrate lower cognitive function when they had low levels of ESS and ISS than of FSS and PSS. ¹⁵ The telecommunication, such as phone or email use, is expected to be more likely to provide emotional and informational support (as opposed to financial or physical support). This study’s findings within the HAALSI Dementia Cohort were consistent and further extend prior research findings.

This study’s results are consistent with those of a previous cross-sectional study that identified an association between higher listener availability and global cognitive function. ¹² Whereas in-person communication may require more resources or effort to connect with someone, telecommunication reduces the burden of speaking with someone directly. It can more easily provide a medium to access high listener availability. Thus, individuals with high levels of TSS might also be more likely to receive high levels of listener availability. Other studies have found that, beyond global cognitive function, the availability of social support is associated with a reduced risk of dementia, thus further supporting the importance of medium that make social support more readily available, such as telecommunication. ¹¹ Although levels of telecommunication was associated with functioning in the domains of executive, visuospatial constructional praxis, and episodic memory in this study, a similar effect of TSS on semantic memory and working memory (as tested by the Boston Naming test) was not found. These results contrast with previous studies and concluded that an individual’s social network size modifies the associations between Alzheimer’s disease pathology and cognitive function in the domains of semantic and working memory. ¹⁴ The findings of this study, which investigated the relationship between social support and dementia in the HAALSI cohort, added to the previous research findings, which were conducted in different populations. The association between higher levels of TSS and better spatial forward, spatial reverse, logical memory (immediate), and logical memory (delayed) cognitive function in the education group than those without education, with reflection of the differences between groups in baseline functioning, supportive social interactions, cognitive reserve, or socioeconomic factors. Agreeing with previous studies, the individuals in the education group may have had greater cognitive functioning at baseline and may decline when faced with a situation lacking social support. ²⁸ Furthermore, individuals in the two groups might have participated in different activities with their peers, thus resulting in differential effects on their cognitive functioning. It would be expected that individuals with education might have been more likely to engage in telecommunication requiring episodic memory, such as email communication about life events, than those without education, who might have had more difficulty using email. ²⁹ Additionally, the notion that education may modify the protective effects of leisure activities and cognitive function has been supported by previous studies. ³⁰ However, the stratified analysis by education revealed differences across cognitive domains, whereas level of education did not show differences in global cognitive function. Thus, although this study supports that education modifies the association between levels of TSS and cognitive functioning, future studies may examine this relationship with greater granularity. Finally, ISS was not associated with cognitive function, and this finding might suggest that not all information received is helpful to individuals, particularly if it is misleading or inaccurate or imposes additional stress, in line with previous research findings.⁷ Overall, the findings of this research have implications for dementia risk stratification in further longitudinal studies focusing on telecommunication and emotional support. In addition, the influence of education on those associations in a diverse South African cohort. The findings may guide future hypothesis generation, studies on social support and cognitive performance, as well as policy implementation to establish a public health program focusing on access to telecommunication, informational, emotional, physical, and financial supports aimed at preventing cognitive decline.

A strength of the present study is its statistical approach, which achieved internal validity through robust regression analysis that reduced the likelihood of systematic errors beyond sample selection in the dementia cohort. In addition, this research further reduced selection bias by applying strict inclusion and exclusion criteria. Finally, the findings of this study are generalizable to the HAALSI cohort and have greater external validity than previous HAALSI research. Similar to other cross-sectional studies, a limitation of this study was the examination of the associations between telecommunication, emotional, physical, informational, and financial social support and cognitive function at a single point in time in the HAALSI population, and the findings do not explain temporality, causality, the possibility of reverse causality, or bidirectional causality. Although the results are generalizable to the HAALSI cohort, the findings of this study still have limited generalizability to broader racial and ethnic groups, given that the sample was drawn from the HAALSI, and information bias could arise when the findings of this study are generalized to different racial and ethnic groups with socioeconomic and medical conditions. As the data collection was a survey study, the possibility of respondent bias in reporting survey questions and limitations in the variables of interest (such as literacy effects, cultural and language issues, and details about the type of education) might be associated with cognitive function. This research did not explore different types of medical conditions beyond vascular risk factors (hypertension or diabetes mellitus). This study did not discuss literacy effects, cultural, and language, as they were not available, and did not include socioeconomic status, marital status/household composition, functional status, and comorbidities as covariates to avoid the possibility that multicollinearity may lead to residual confounding. However, this study examines the role of physical support and explains whether the need for support from impaired functional status and financial support may explain the need for financial support among disadvantaged socioeconomic status groups.

5. Conclusions

Higher levels of telecommunication and emotional social support over the preceding 6 months were associated with greater global cognitive function and improved performance in specific cognitive tasks requiring executive function, sustained attention, visuospatial awareness, and episodic memory in the 2019–2020 HAALSI cohort. This relationship was further modified by participants’ level of education attained. These findings guide a further prospective study to investigate the temporal association of those and also help guide public health policy to establish public health programs that prevent cognitive decline and inform prospective studies that would further understand the complex pathways between social support and cognitive function.

Acknowledgement: This study was conducted as post-doctoral researcher with Neurology Department at NYU in 2021-2022.

 

Figure 4. Illustration of Principal Component in Rotated Sapace regarding cognitive function assessments

Table 1. Characteristics of Study Participants in HAALSI Dementia Cohort (2019-2020)

No known conflict of interest to disclose.

This research was conducted by Kay Thwe Kyaw while affaliated with Neurology Department of NYU in 2021-2022.

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Suggested Citation: Kyaw, Kay Thwe. “Associations of Social Supports and Cognitive Functions. .” Kaytharalotus, 2026, https://kaytharalotus.com/publications/.