Intimacy, Sexuality, and Cognitive Decline in Older Adults With Mild Neurocognitive Disorder and Mild-Stage Major...

To examine whether dimensions of intimacy and sexuality may be associated with cognitive decline in older patients with mild neurocognitive disorder (NCD) and mild-stage major NCD.

In this 12-month prospective observational study conducted at two outpatient cognitive disorders centers in Southern Italy, 56 patients with mild NCD and 57 patients with mild-stage major NCD, diagnosed according to DSM-5 criteria, were enrolled.

Cognitive function was assessed using the Mini-Mental State Examination (MMSE) at baseline and follow-up. Four dimensions of intimacy and sexuality-including romance with one's partner, sexual satisfaction, beliefs about sexuality, and social support and emotional intimacy-were evaluated using the Interpersonal Relations, Intimacy, and Sexuality Survey. Linear mixed-effects models were used to estimate cognitive change over time.

MMSE scores declined over 12 months (Time: b = -1.24, SE = 0.131, t (113) = -9.49, p < 0.001). Higher levels of sexual satisfaction and romance were associated with slower cognitive decline, independent of demographic and clinical covariates including age, sex, education, and multimorbidity. Social support and emotional intimacy showed modest associations with cognitive trajectories, whereas beliefs about sexuality were not significantly related to cognitive changes. These associations were consistent across the diagnostic groups, with only slight differences observed in the relationship between intimacy-related variables and overall MMSE scores.

Intimacy-related dimensions-particularly sexual satisfaction and romance-were associated with attenuated cognitive decline in early-stage NCD. These findings highlighted the potential role of relational and psychosocial factors in cognitive resilience and suggested relevant targets for non-pharmacological interventions.