Prevalence and risk factors of loneliness in older adults with preclinical and prodromal Alzheimer's disease: the impact of depression, frailty-weight loss and quality of life

Emerging evidence suggests that loneliness may further exacerbate cognitive impairment. This study aimed to assess loneliness and identify its associated factors among older adults with preclinical and prodromal Alzheimer’s disease (AD), thereby providing evidence for improving cognitive continuum management. A community-based cross-sectional study was conducted in Fuzhou, China, using convenience sampling. Participants were assessed for loneliness, social participation, anxiety, depression, frailty, quality of life, and social function using validated scales. Data were analyzed using Pearson’s correlation and stepwise linear regression to identify independent predictors of loneliness. A total of 215 older adults with preclinical and prodromal AD were enrolled in this study, and 205 of them (95.3%) completed the questionnaire. Most older adults (79.5%) with preclinical and prodromal AD experienced mild to moderate loneliness. The study revealed a significant negative correlation between frailty-weight loss and loneliness (p < 0.05). Key findings include increased loneliness among individuals who live alone (p < 0.05), have lower social participation (p < 0.05), engage less in community activities (p < 0.01), exhibit lower quality of life scores (p < 0.01), and higher anxiety scores (SAS, p < 0.01) and depression scores (GDS-15, p < 0.01) . Loneliness is highly prevalent among community-dwelling older adults along the early stages of AD continuum. Loss of weight (as a frailty component), living alone, and poor social participation are significant risk factors for increased loneliness, which is further exacerbated by psychological distress (anxiety and depression) and diminished quality of life. Future intervention strategies should prioritize frailty screening and social support networks to enhance quality of life and alleviate loneliness in the early stages of the AD continuum.