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

Re: Brain reserve or better strategic behaviour?

Mairead Bartley, in response to our article on midlfe marital status
and cognitive health in later life, (1) suggests that adaptive coping
strategies in old age are related to successful aging and health. We have
no reason to disagree, but the critical question is of course what is the
hen and what is the egg behind this relation: Are more efficient coping
strategies in later life a sign of better cognitive functioning or is it
natural for people with better cognitive health to use more efficient
coping strategies? It was for this reason we emphasized in the article the
associations between variables we found already in midlife and cognitive
health averagely 21 years later.

One of the results we found, not mentioned in the article, was
however the association with cognitive health for the group that had lost
their partner in midlife, but were living in a partner relation at the
follow-up. There were 23 persons in this category and none of them showed
any signs of cognitive impairment at the follow-up. This result fits
nicely with the point that M Bartleys makes in her response: “The
maintenance, renewal, and coping with loss of relationships with a partner
may in some way reflect successful adaptive mechanisms.” The reason we did
not mention this result in the article was, besides the shaky statistical
foundation with only 23 persons in this group, the point about reverse
causation mentioned above: The decision and ability to form a new couple
relation after midlife may be related to better health, including better
cognitive health, already when these persons entered into the new couple
relation. If so, and if these persons also manifest better cognitive
health a few years later, this should not be surprising. On the other
hand, even if not evidential, the results may still be of interest in
discussing the possibility of a causal relation of the kind that Mairead
Bartley suggests in her comment.

1. Hakansson K, Rovio S, Helkala E-L, Vilska A-R, Winblad B, Soininen
H, Nissinen A, Mohammed AH, Kivipelto M. Association between mid-life
marital status and cognitive function in later life: population based
cohort study. BMJ. 2009;339(jul02_2):b2462-.

Competing interests:
None declared

Competing interests: No competing interests

07 August 2009
Krister Håkansson
research fellow
Miia Kivipelto
Växjö University, 35195 Växjö and the Karolinska Institutet, 14186 Stockholm, Sweden