Association between mid-life marital status and cognitive function in later life: population based cohort study

doi:10.1136/bmj.b2462

Published 2 July 2009, doi:10.1136/bmj.b2462
Cite this as: BMJ 2009;339:b2462

Research

Association between mid-life marital status and cognitive function in later life: population based cohort study

Krister Håkansson, research fellow¹^,2, Suvi Rovio, research fellow², Eeva-Liisa Helkala, neuropsychologist³, Anna-Riitta Vilska, lecturer⁴, Bengt Winblad, professor², Hilkka Soininen, professor⁵^,6, Aulikki Nissinen, professor⁷, Abdul H Mohammed, professor¹^,2, Miia Kivipelto, associate professor²^,5

¹ School of Social Sciences, Department of Psychology, Växjö University, Sweden , ² Aging Research Centre, Department of Neurobiology, Caring Sciences and Society, Karolinska Institute, Stockholm, Sweden, ³ Department of Public Health and General Practice, University of Kuopio, Kuopio, Finland, ⁴ Savonia University of Applied Sciences, Kuopio, Finland, ⁵ Department of Neuroscience and Neurology, University of Kuopio, Kuopio, Finland , ⁶ Department of Neurology, Kuopio University Hospital, Kuopio, Finland, ⁷ Department of Health Promotion and Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

Correspondence to: M Kivipelto, Department of NVS, KI - Alzheimer’s Disease Research Centre, Karolinska Institute, S-141 86 Stockholm, Sweden Miia.Kivipelto{at}ki.se

Objectives To evaluate whether mid-life marital status is relatedto cognitive function in later life.

Design Prospective population based study with an average follow-upof 21 years.

Setting Kuopio and Joensuu regions in eastern Finland.

Participants Participants were derived from random, populationbased samples previously investigated in 1972, 1977, 1982, or1987; 1449 individuals (73%), aged 65-79, underwent re-examinationin 1998.

Main outcome measures Alzheimer’s disease and mild cognitiveimpairment.

Results People cohabiting with a partner in mid-life (mean age50.4) were less likely than all other categories (single, separated,or widowed) to show cognitive impairment later in life at ages65-79. Those widowed or divorced in mid-life and still so atfollow-up had three times the risk compared with married orcohabiting people. Those widowed both at mid-life and laterlife had an odds ratio of 7.67 (1.6 to 40.0) for Alzheimer’sdisease compared with married or cohabiting people. The highestincreased risk for Alzheimer’s disease was in carriersof the apolipoprotein E e4 allele who lost their partner beforemid-life and were still widowed or divorced at follow-up. Theprogressive entering of several adjustment variables from mid-lifedid not alter these associations.

Conclusions Living in a relationship with a partner might implycognitive and social challenges that have a protective effectagainst cognitive impairment later in life, consistent withthe brain reserve hypothesis. The specific increased risk forwidowed and divorced people compared with single people indicatesthat other factors are needed to explain parts of the results.A sociogenetic disease model might explain the dramatic increasein risk of Alzheimer’s disease for widowed apolipoproteinE e4 carriers.

© Håkansson et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Marital status and dementia: Rizaldy Pinzon
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