System dynamics model on the interplay between social health and dementia

Abstract

AbstractBackgroundDementia, as a multi‐factorial condition with complex underlying mechanisms, demands a comprehensive approach of prevention and treatment, especially, focused on psychosocial interventions. This work is aimed at presenting a system dynamics (SD) model on the role of social health in the trajectory from cognitive health to dementia.MethodWe used a staged approach for building a SD model, presenting SH‐cognition bidirectional relationship, based on (1) systematic literature review on factors related to cognitive decline, (2) Group Model Building sessions with interdisciplinary experts, (3) iterative way of integrating results from epidemiological, multi‐national cohort studies, (4) ongoing revisions of SH concept via structured discussions between experts. This knowledge synthesis was harmonized and transformed into a causal pathway model in Kumu program (https://kumu.io/).ResultThe SD model presents maps on three levels: health domains, concepts with dimensions, markers. The last is a representation of interaction and feedback mechanisms between social health and cognition through three pathways: Physiological, psychological, and health‐behavioral, and through, so called ‘cognitive reserve & brain reserve’. Each marker is described with definitions and level of evidence (from expert’s knowledge to systematic review). The outcome shows that multiple SH factors contribute to cognitive decline and dementia (e.g. loneliness, being single), being risk factors, and other serve as protective factors (e.g. high social frequency, social support). In return, presence of dementia symptoms influences SH, f.ex. making the individual more dependent on social network, or being less satisfied with social ties.ConclusionThe SD model elucidates dynamic and complex relationships between dementia and SH, which might serve a role of a reserve in the context of changed roles in social life of an individual with dementia. This novel representation will be translated into key elements and targets for recommendations for interventions, both for prevention and for improved dementia care.