Marital status and dementia risk

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"Being married protects you against Alzheimer's in later life," the Daily Mail reported. The newspaper said that researchers found that people who have a partner in middle age have half the risk of developing dementia as those who live alone. However, getting divorced or becoming widowed in middle age triples the risk of dementia.

It has often been suggested that marital status has an impact on health and quality of life. This study assessed the relationship between marital status in 2,000 middle-aged people (average age 50) and their cognitive impairment about 21 years later. It found that the risk of any cognitive impairment almost doubled if a person was alone in middle age compared to having a partner. Being without a partner in both middle age and later life further increased risk. measured at the start of the study, so it is difficult to prove that marital status is related to cognitive impairment in later life. If the association does exist, the reasons behind it are difficult to establish. The risk of dementia is likely to be governed by a complex interaction of several factors, such as lifetime personal, social and intellectual interactions, health, lifestyle and medical and genetic factors. The research was carried out by Krister Håkansson from the Department of Psychology at Växjö University, Sweden, and colleagues from other institutions in Sweden and Finland.

This cohort study assessed whether being married in middle age is related to cognitive function in later life. It used participants from a previous study called the cardiovascular risk factors, aging and dementia (CAIDE) study. These people were recruited from four separate population samples in 1972, 1977, 1982 and 1987. The four samples were randomly selected from the population register of the Kuopio and Joensuu regions of eastern Finland and consisted of 30,078 adults aged 30 to 59 (average age 50.4 years). The sample was stratified so that there were at least 250 participants from each sex and from each of three 10-year age intervals. In 1998, 2,000 surviving members of this cohort were randomly selected to be interviewed again, 1,449 of whom (73%) chose to participate. By this time, they were aged 65–70 and the average follow-up time was 20.9 years.

At the beginning of the study and then at follow-up, the researchers assessed the participants’ marital status and categorised them as single, married/cohabiting, divorced or widowed. They combined data on marital status at the two time points to create different categories of marital transition, for example whether participants were married at both times or married then widowed. At follow-up, cognitive impairment was assessed using the mini-mental state examination (MMSE) for screening. The results of this were then used to decide whether further clinical examination and diagnostic testing (including brain imaging) were needed. Dementia was diagnosed using valid diagnostic criteria and defined as either mild cognitive impairment, Alzheimer’s disease or other forms of dementia. The researchers also used laboratory methods to investigate whether participants were carriers of the apolipoprotein E e4 allele (considered to be a risk factor for Alzheimer’s and vascular dementia). For the 551 selected participants who chose not to take part in the 1998 assessments, information on diagnoses of dementia was obtained from local hospitals and healthcare centres.

n their analyses, the researchers collapsed the middle-age marital status categories into the following: living with a partner/married, single, separated/divorced, or widowed. They combined marital status in middle-age and later life to give the following categories of marital transition: cohabiting with a partner on both occasions, cohabiting with a partner in middle age but not in later life, and living without a partner on both occasions. (The researchers said that too few people were single in middle age but cohabiting in later life to be included in the analyses). The researchers assessed the relationship between marital status and cognitive impairment in later life, taking into account (adjusting for) other possible risk factors (assessed in middle age) of apolipoprotein E e4 allele status, education and occupation, sex and age, smoking, BMI, blood pressure, cholesterol, physical activity and depression.

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