🏠 In MCI, living with relatives tied to lower cognition

The missing link in MCI cognitive performance may be who patients live with: in a National Alzheimers Coordinating Center cross-sectional analysis of 9,334 people with mild cognitive impairment (mean age 72.9), those living with a relative/friend had lower cognitive performance than those living alone. Depressive symptoms (via the Geriatric Depression Scale) partially mediated this association, accounting for ~10% of the effect in MCI (and ~7% in cognitively normal adults).

Why It Matters To Your Practice

▪ Household composition may signal psychosocial stressors that correlate with lower cognition in MCIespecially when the cohabitant is a relative/friend rather than a spouse/partner.

▪ Depressive symptoms may be one pathway linking living situation to cognitive performance, making mood screening clinically actionable in this context.

Clinical Benefits

▪ Add a quick “who do you live with?” screen (alone vs spouse/partner vs relative/friend) to MCI visits to refine risk context and care planning.

▪ Use elevated GDS scores as a cue to intensify supports (behavioral health referral, caregiver counseling, community resources) alongside cognitive follow-up.

▪ When feasible, tailor counseling: living alone is not automatically higher-risk for cognition compared with living with a relative/friend in MCI in this dataset.

Managing Risks

▪ Avoid causal language: this was cross-sectional, so living with relatives/friends may be a marker of worsening function, financial strain, caregiver burden, or other confounders.

▪ Do not assume the cohabiting relative/friend relationship is harmful; assess for caregiver stress, interpersonal conflict, unmet ADL/IADL needs, and safety concerns (med adherence, falls, wandering).

▪ Screen for depression and suicidality when symptoms are present; treat per guidelines (psychotherapy, SSRIs/SNRIs when appropriate) and coordinate with neurology/geriatrics.

The Bottom Line

▪ In MCI, living with a relative/friend was associated with lower cognitive performance than living alone in a large NACC cross-sectional study, with depressive symptoms mediating ~10% of the association.

▪ For NPs and PAs, living situation + depression screening can help target counseling, supports, and follow-upwithout over-interpreting causality.