Intended for healthcare professionals


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

BMJ 2009; 339 doi: (Published 02 July 2009) Cite this as: BMJ 2009;339:b2462

Brain reserve or better strategic behaviour?

We read with interest Hakansson and colleagues’ study of mid-life
marital status and cognitive function in later life (1). They acknowledge
that factors other than the brain reserve hypothesis may account for the
possible protective effect of a partner on cognition. Adaptive and coping
strategies are an under-recognized component of successful cognitive
ageing, and are worth considering in this study.

For example, the theory of selection, optimization and compensation
outlines strategies of adaptively responding to the challenges of ageing
(2) which have been associated with successful ageing (3). Resource-rich
(both internal and external) older adults have been shown to engage in
these strategies more frequently, associated with the maintenance of
higher levels of everyday functioning. The maintenance, renewal, and
coping with loss of relationships with a partner may in some way reflect
successful adaptive mechanisms.

That the results for being widowed or divorced after mid-life had
only borderline significance may be explained in part by the ongoing
development of altered coping strategies of older people. In a review of
coping strategies after stroke, a trend was seen towards the use of active
problem-oriented coping strategies, which may be more effective in the
long term (4). It may be reasonable to extrapolate this to the coping
strategies of someone widowed in later life. Therapeutic advantage in the
pursuit of better strategic thinking is supported by the effectiveness of
reasoning training in later life in delaying the onset of functional
decline among older people (5).

1. Hakansson K, Rovio S, Helkala EL, Vilska AR, Winblad B, Soininen
H, et al. Association between mid-life marital status and cognitive
function in later life: population based cohort study. BMJ.

2. Lang FR, Rieckmann N, Baltes MM. Adapting to aging losses: do resources
facilitate strategies of selection, compensation, and optimization in
everyday functioning? J Gerontol B Psychol Sci Soc Sci. 2002;57:P501-9.

3. Ziegelmann JP, Lippke S. Use of selection, optimization, and
compensation strategies in health self-regulation: interplay with
resources and successful development. J Aging Health. 2007;19:500-18.

4. Donnellan C, Hevey D, Hickey A, O'Neill D. Defining and quantifying
coping strategies after stroke: a review. J Neurol Neurosurg Psychiatry.

5. Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, Morris
JN, Rebok GW, Unverzagt FW, Stoddard AM, Wright E; ACTIVE Study Group.
Long-term effects of cognitive training on everyday functional outcomes in
older adults. JAMA. 2006;296:2805-14.

Competing interests:
None declared

Competing interests: No competing interests

15 July 2009
Mairead Bartley
Research Fellow
Desmond O'Neill
Trinity Cantre for Health Sciences, Adelaide and Meath Hospital, Dublin 24, Ireland