Spousal Loss and Cognitive Function in Later Life: A 25-year Follow-up in the AGES-Reykjavik Study
Halldora Vidarsdottir
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1
Fang Fang
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Milan Chang
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Thor Aspelund
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Katja Fall
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Maria K. Jonsdottir
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1
Palmi V. Jonsson
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1
Mary Frances Cotch
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Tamara B. Harris
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Lenore J. Launer
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Vilmundur Gudnason
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Unnur Valdimarsdottir
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Abbreviations: AGES, Age, Gene/Environment Susceptibility; ApoE
,
apolipoprotein E
1
Author affiliations: Centre of Public Health Sciences, Uni- versity of Iceland
,
Reykjavik, Iceland (Halldora Vidarsdottir, Thor Aspelund
,
Unnur Valdimarsdottir); Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (Fang Fang); Geriatric Research Center, National University Hospital
,
Reykjavik, Iceland (Milan Chang
,
Maria K. Jonsdottir, Palmi V. Jonsson); Department of Sports Science, School of Science and Engineering, Reyk- javik University
,
Reykjavik
,
Iceland (
Milan Chang); Icelandic Heart Association
,
Kopavogur, Iceland (Thor Aspelund
,
Vilmundur Gudnason); Department of Clinical Epidemiol- ogy and Biostatistics, Orebro University Hospital
,
Orebro
,
Sweden (
Katja Fall); Faculty of Psychology, University of Iceland
,
Reykjavik
,
Iceland (
Maria K. Jonsdottir); Faculty of Medicine, University of Iceland
,
Reykjavik, Iceland (Palmi V. Jonsson
,
Vilmundur Gudnason); Department of
American Journal of Epidemiology The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: . The aim of this study was to investigate the associations between loss of a life partner and the development of dementia and decline in cognitive function in later life. We used an Icelandic cohort of 4,370 participants in the Age, Gene/Environment Susceptibility-Reykjavik Study who were living as married in 1978 (born in 1907-1935) and were either still married (unexposed cohort) or widowed (exposed cohort) at follow-up (in 2002-2006). We ascertained history of marital status and spouse's death by record linkage to the Registry of the Total Population, Statistics Iceland. The outcome measures were as follows: 1) dementia and mild cognitive impairment; and 2) memory, speed of processing, and executive function. During the observation period, 3,007 individuals remained married and 1,363 lost a spouse through death. We did not find any significant associations between loss of a spouse and our outcome variables, except that widowed women had poorer executive function (mean = 0.08) during the first 2 years after their husbands' deaths compared with still-married women (mean = 0.09). Our findings do not support the notion that the risk of dementia is increased following the loss of a spouse, yet women demonstrate a seemingly temporary decline in executive function following the death of a partner. dementia; executive function; marital status; memory; psychological stress
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Neurodegenerative disorders leading to cognitive
impairment have become one of the largest public health threats
of modern times. Although risk factors remain to a large
extent unknown, a growing body of research, both in animal
models (13) and in humans (411), suggests an impact of
psychological stress on cognitive impairment. Studies
incorporating various measures of psychological distress (46)
and psychiatric disorders (711) have reported an association
with cognitive decline in older adulthood.
Loss of a spouse has been classified as one of the most
stressful events a person can encounter (12). Indeed,
widowed individuals have been shown to be at increased risk
for psychological morbidity (13) and higher overall mortality
(14) compared with married individuals. Animal models
suggest that the introduction of a stressful environment impairs
an animals problem-solving skills (1517) and reduces the
volumes of important memory structures, such as the
hippocampus (18, 19). Proposed mechanisms between stressful life
events, such as bereavement, and cognitive decline in
humans have accordingly been suggested to include
hippocampal atrophy from stress-induced glucocorticoid secretion (20,
21) fueled by emotional trauma, as well as increased
vulnerability to stress from diminished social support and
interactions (22, 23).Yet relatively few studies have specifically
investigated the association between marital status change
and cognitive decline. Some have found increased risk of
cognitive decline in widowhood (2427), whereas others
have not (2830). In a recent population-based cohort study,
Hkansson et al. (31) monitored changes in marital status and
cognitive function in 1,449 Finns followed for an average of
21 years. They reported a markedly increased risk of
cognitive impairment and Alzheimers disease among those
widowed in midlife and at follow-up compared with those
who lived with a partner during the time period. With the
detailed information on dementia and cognitive function
from the Age, Gene/Environment Susceptibility
(AGES)Reykjavik Study and complete ascertainment of marita (...truncated)