Exploring the relationship between marital quality and cognitive function: A systematic review

Cognitive function is an important indicator of healthy aging as it is central to maintaining functional independence, performing job-related tasks, decision-making, and improving quality of life. Therefore, researchers seek to identify biopsychosocial factors that can help preserve cognitive function in aging individuals. One such factor is the maintenance of good quality marital relationships. Research has consistently shown that married individuals fare better in terms of both physical and psychological health compared to their unmarried counterparts. However, being married is not universally beneficial - the quality of a marriage is also important to consider. To explore the issue further, we conducted a systematic review to examine the association between marital quality and cognitive function. PubMed, PsycINFO, and Scopus were searched for eligible articles examining any measure of marital quality and any cognitive outcome from the inception of each database to January 9th, 2024. Following two levels of citation screening by two independent reviewers, we included 15 articles representing 11 unique studies. Data were synthesized narratively following the Synthesis without Meta-Analysis guidelines and a risk of bias assessment was conducted using the Joanna Briggs Institute checklist. Most articles had a low risk of bias. Although some findings suggested more positive marital quality was associated with improved cognitive function, the results were not uniformly positive; some results were inverse or null, depending upon factors such as differences in study designs and measures of marital quality or cognition. This review is the first attempt to synthesize the literature on this topic. Our findings highlight that any examination of marital status and cognition should also consider contextual factors such as marital quality.

Are you more impulsive with age? Examining age, marital status, and gender on cognitive ageing

Understanding non-pathological cognitive aging processes remains a public health goal and research priority. Age-associated cognitive aging is a normal human process, however, individual differences may aid in the mitigation of cognitive aging. Assessing the role of certain protective factors (i.e., age, marital status, and gender) that influence age-related cognitive aging is imperative to slow down the progression of unwarranted cognitive aging. Participants aged over 18 (N = 123; 97 females and 26 males) recruited from Sydney, New South Wales, and Gold Coast, Queensland, completed an online neuropsychological test battery with computer-administered tasks, assessing impulsivity and working memory, which were entered as dependent variables. A 3(Age Group: 18-27 years; 28-61 years; 62+ years) x2(Marital Status: married; single) x2(Gender: male; female) Multivariate Analysis of Covariance (MANCOVA) design was used to examine the relationship between age, marital status, and gender (entered as independent variables) on cognitive aging. Participants' total scores from psychometrically sound measures assessing depressive symptomology, personal wellbeing, resilience, and social network engagement, were entered as covariates. No significant effects were found from the independent variables included in the MANCOVA. A significant covariate effect for resilience and depressive symptomology on impulsivity was found. A multiple regression analysis was performed on the significant covariates, and revealed increased resilience and depressive symptomology to significantly predict greater impulsivity.

Does losing family members in midlife matter for late-life mental and cognitive health? A longitudinal study of older Swedes spanning 30 years

OBJECTIVES

Mental and cognitive health is crucial to ensure well-being in older age. However, prolonged periods of stress, grief, and bereavement might compromise mental health balance, leading to profound changes. This study investigated the sex-stratified associations between midlife bereavement experiences (e.g. sibling loss, spousal loss, and multiple losses) and late-life depression (LLD) and cognitive impairment.

METHOD

Linked data from the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were used. Multiple logistic regressions were performed to examine the associations between midlife bereavement and LLD (n = 1078) and cognitive impairment (n = 995), separately.

RESULTS

Sibling loss and multiple losses in midlife were associated with lower odds of LLD, especially among women. Among men, sibling loss in midlife was associated with lower odds of cognitive impairment, while the experience of two losses among women suggested an increased (but non-significant) risk of cognitive impairment. Interaction analyses did not show significant effects between bereavement and gender on LLD and cognitive impairment.

CONCLUSION

Midlife bereavement might have gendered implications on LLD and cognitive impairment, but associations need to be confirmed by well-powered studies. Further research is warranted to elucidate the association between multiple midlife losses and reduced LLD risk.

Determinants of semantic and episodic memory decline among older adults in Ghana: Evidence from the WHO study on global AGEing and adult health Ghana wave 2

Objective

Determined factors associated with semantic (SM) and episodic memory (EM) among older adults aged 50 years and older in Ghana.

Methods

Data from WHO Study on Global AGEing and Adult Health (SAGE) Ghana Wave 2 was used for this study. Semantic memory (SM) and Episodic memory (EM) were the main study outcomes separately. The study employed Nested Ordinary Least Square regression analysis by sequentially adding 6 blocks of variables and comparison tests between the nested models.

Results

The study involved 3575 adult Ghanaians aged 50 years and older with a mean ± standard deviation of 62.6 ± 18.4 years. The overall mean ± SD of EM and SM were 5.86 ± 2.51 and 11.69 ± 8.59 respectively. Overall, analysis from block 6 showed a significant variation in SM by approximately 16.9%(ΔR2 = 1.17%) where increasing age, never married (β = -1.55; 95% CI = -2.41-0.69), being resident in Greater Accra (regional disparity) (β = -3.45; 95% CI = -4.73-2.20), underweight (β = -0.81;95% CI = -1.34-0.27), and moderate self-rated health (SRH) (β = -0.98; 95% CI = -1.52-0.45) significantly decreased SM. Similarly, increasing age, separated/divorced (β = -0.22; 95% CI = -0.35-0.87), being resident in Greater Accra (β = -0.53; 95% CI = -0.80-0.26), and moderate SRH (β = -0.20; 95% CI = -0.36--0.04) significantly decrease EM with an overall significant variation of approximately 22.9%(ΔR2 = 2.7%).

Conclusions

Increasing age, sex, marital status, regional disparity, and poor SRH significantly decreased both Semantic memory and Episodic memory. Higher educational attainment and life satisfaction significantly influenced SM and EM. These provide pointers to important socio-demographic determinants of SM and EM with implications for the implementation of the Ghana national ageing policy 2010, 'ageing with security and dignity', and as a key consideration for healthy ageing towards 2030.

Examining the association between functional social support, marital status, and memory: a systematic review

BACKGROUND

Functional social support (FSS) has been shown to be positively associated with better cognitive function, especially memory, in cross-sectional and longitudinal studies. To better understand this complex association, researchers should consider the impact of additional factors that affect both FSS and memory. Therefore, we conducted a systematic review to examine whether one such factor, marital status or related variables (e.g., FSS from spouses compared to FSS from relatives or friends), affects (e.g., confounds or modifies) the association between FSS and memory in middle-aged and older adults.

METHODS

We searched PubMed, PsycINFO, and Scopus from database inception to June 2022. Eligible articles examined the association between FSS and memory, and included marital status or related variables in the analysis. Data were synthesized narratively and reported in accordance with the Synthesis without meta-analysis (SWiM) guidelines; risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

Four articles were included in the narrative synthesis. All four articles had a low risk of bias. Overall findings suggested some positive associations between FSS from a spouse/partner and memory; however, effect sizes were small and similar to other sources of support, including children, relatives, and friends.

CONCLUSIONS

Our review is the first attempt to synthesize the literature on this topic. Despite theoretical support for examining the impact of marital status or related variables on the association between FSS and memory, published studies explored this issue secondarily to other research questions.

Spousal loss and cognitive function: the importance of gender and multiple dimensions of marital quality

Objectives: Research suggests that the death of a spouse has an adverse effect on a widow(er)'s cognition. However, little research has examined how the marital context before widowhood and gender influence this association. Guided by the social ambivalence and disease (SAD) model, this study examined the associations between spousal loss and cognition , with moderating effects of gender and pre-loss marital quality.Method: We analyzed a national longitudinal data, Midlife in the United States (MIDUS), specifically MIDUS 2 (2004-2005) and MIDUS 3 (2013-2014). The analytic sample consisted of (1) 146 participants who experienced the death of their spouse between MIDUS 2 and MIDUS 3 and (2) 144 age- and gender-matched comparison participants who did not lose their spouse during the period.Results: Adverse influence of widowhood on cognition was more pronounced among bereaved men than bereaved women. Widowed individuals whose relationships with their deceased spouse were ambivalent had poorer cognition than widowed individuals who had aversive relationships with their deceased spouse.Conclusion: Findings suggest that the influence of spousal death on cognitive functioning depends on gender and pre-loss marital quality, emphasizing the importance of considering pre-loss marital relationship and gender dynamics in developing efficient interventions for the widowed.

Examining the Combined Effects of Social Isolation and Loneliness on Memory: A Systematic Review

BACKGROUND

Some research suggests social isolation and loneliness are important risk factors for reduced successful aging and cognitive health. However, findings are inconsistent and no prior systematic review has investigated whether social isolation and loneliness are associated with the memory domain of cognition. This review examined whether social isolation and loneliness individually and jointly affected the memory of middle- and older-aged adults.

METHODS

We used PubMed, PsycInfo, and Scopus to search for comparative studies that examined the impact of both loneliness and social isolation (e.g., social activity, social networks) on memory (including all subtypes) in populations aged ≥ 45 years. Three raters performed data extraction and risk of bias assessment using the Joanna Briggs Institute checklist. Data were synthesized narratively following the Synthesis without Meta-Analysis guideline.

RESULTS

In 12 included articles, higher levels of loneliness and social isolation (combining a range of different indicators) were associated with lower memory performance, where the interaction between loneliness and social isolation had the largest adverse effect on memory, followed by social isolation alone, and followed by loneliness alone. However, substantial heterogeneity was observed in the composition of the two most common indicators of social isolation (social network size, social activity participation), with the magnitude of most results being clinically non-important. Most articles had moderate risk of bias.

CONCLUSION

This review found an inverse association between social isolation/loneliness and memory, and outlines future steps to systematically combine the two constructs and measure social isolation in a consistent, multi-modal format.

Familial factors, depression and cognitive decline: A longitudinal mediation analysis based on latent growth modeling (LGM)

BACKGROUND

Cognitive decline of ageing population has become one of the major public health challenges worldwide, and familial factors (such as household income, marital status, etc.) have been identified as risk factors. Currently, we mainly focused on two familial factors: living with spouse/child and intergenerational rearing (taking care of grandchildren), exploring their relations with cognitive ageing. We also tested the possible mediating role of depression between the two family factors and cognitive decline.

METHODS

Data was derived from China Health and Retirement Longitudinal Study (CHARLS) database, and a total of 8474 participants (3602 females, mean age = 69.64) were included in the current research. Latent growth model (LGM) has been constructed for cognitive functions, with initial level and declining rate being estimated respectively. We further examined: (1) whether living with spouse/child and intergenerational rearing could influence the declining trajectory (initial level and declining rate) of elders' cognitive functioning; (2) and if so, whether depression could mediate the effects of living with spouse/child and intergenerational rearing on cognitive functioning.

RESULTS

First, while living with spouse/child was related to higher initial level of cognitive functions and slower declining rate, intergenerational rearing was associated with neither of them. Second, growth trajectory of depression partly mediated the effects of living with spouse/child on cognitive functioning (Indirect effect = 0.14; p < 0.01).

CONCLUSIONS

Familial factors (living with spouse/child and intergenerational rearing) may be influential on declining trajectories of elders' cognitive functions, and depression may mediate such effects. More research efforts are needed to investigate the mechanisms underlying the relations between familial factors and cognitive ageing.

Indoor Environmental Quality of Residential Elderly Care Facilities in Northeast China

The indoor environmental quality is based on the indoor environmental performance of buildings, such as air temperature, lighting, and acoustics. These parameters have a specific impact on users' health and experience. This study explores the relationship between the indoor environment of residential elderly care facilities in cold regions and the sensitivity of the elderly to these facilities with the aim of improving the elderly care environment. This study measured the acoustic, lighting, and thermal environment in four residential elderly care facilities in Northeast China in spring, summer, autumn, and winter through a participant survey. In the residential elderly care facilities surveyed in this study, brightness and illuminance show a nonlinear relationship with lighting evaluation. With an increase in brightness and illuminance, the satisfaction of the lighting environment in different seasons first increases and then decreases. The relative humidity of the different types of rooms varies greatly in spring and less in winter. The average air quality score of the bedroom is higher than that of the activity room. The correlation between odor assessment and overall indoor environmental quality is very poor. The results of the questionnaire survey indicate that the participants were satisfied with the facilities' overall indoor environmental quality. This quality is affected by physical, environmental, and demographic factors. This study provides a reference for the design of other residential elderly care facilities.

The Role of Purpose in Life in the Relationship Between Widowhood and Cognitive Decline Among Older Adults in the U.S

OBJECTIVES

The objective of this study was to examine the role of purpose in life in the relationship between widowhood and cognitive decline.

METHODS

This study used a sample of 12,856 respondents (20,408 observations) collected from a national panel survey, the 2006-2014 waves of the Health and Retirement Study (HRS), that sampled older adults aged 50 or older. The study estimated growth-curve models with years since spousal death, purpose in life, and interaction between the two to predict cognition using three measures-total cognition, fluid, and crystallized intelligence scores. We also estimated growth-curve models by sex, race/ethnicity, and education.

RESULTS

While years since spousal death negatively correlated with cognition, purpose in life positively correlated with cognition. Furthermore, purpose in life had a moderating effect on the relationship between years since spousal death and cognition. This effect was found by using total cognition (coef. = 0.0515; z = 2.64; p < 0.01) and fluid intelligence scores (coef. = 0.0576; z = 3.23; p < 0.05). The same effects were salient among females (coef. = 0.0556; z = 2.19; p < 0.05), Whites (coef. = 0.0526; z = 2.52; p < 0.05), and older adults with more education (coef. = 0.0635; z = 2.10; p < 0.05).

CONCLUSION

Higher purpose in life relates to the negative correlations between widowhood and cognition of older adults. Educational programs improving purpose in life are a possible avenue for reducing the adverse effect of widowhood on cognition and warrant future exploration.

Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood

Accumulating research suggests that stressful life events, especially those that threaten close intimate bonds, are associated with an increased risk of dementia. Grieving the loss of a spouse, whether in the form of caregiving or after the death, ranks among 'life's most significant stressors', evoking intense psychological and physiological distress. Despite numerous studies reporting elevated dementia risk or poorer cognition among spousal caregivers and widow(er)s compared to controls, no review has summarized findings across cognitive outcomes (i.e., dementia incidence, cognitive impairment rates, cognitive performance) or proposed a theoretical model for understanding the links between partner loss and abnormal cognitive decline. The current systematic review summarizes findings across 64 empirical studies. Overall, both cross-sectional and longitudinal studies revealed an adverse association between partner loss and cognitive outcomes. In turn, we propose a biopsychosocial model of cognitive decline that explains how caregiving and bereavement may position some to develop cognitive impairment or Alzheimer's disease and related dementias. More longitudinal studies that focus on the biopsychosocial context of caregivers and widow(er)s are needed.

Widowhood and cognitive decline in adults aged 50 and over: A systematic review and meta-analysis

While widowhood is known to be associated with poorer physical and mental health outcomes, studies examining the association of widowhood with cognition have yielded mixed results. This review aimed to elucidate the link between widowhood and cognitive decline. A systematic search of Medline, Embase, PsycInfo, CINAHL and Scopus (until December 2020) was conducted to identify studies on the association between widowhood (vs. being married) and cognition in cognitively healthy adults aged 50 +. A cross-sectional meta-analysis (of 10 studies; n = 24,668) found a significant association of widowhood with cognition (g = - 0.36, 95% CI [- 0.47, - 0.25], p = < 0.001). Meta-regressions suggested that study design, cognitive domain measured, sample age, difference in mean age between widowed and married groups, and study continent did not account for observed heterogeneity. A longitudinal meta-analysis (of 3 studies; n = 10,378) found that the "continually widowed" group (from baseline to follow-up) showed significantly steeper declines in cognition compared to the "continually married" group (g = - 0.15, 95%CI [- 0.19, - 0.10], p = < 0.001). Findings indicate that widowhood may be a risk factor for cognitive decline. As there are no effective treatments for cognitive impairment, studying mechanisms by which widowhood might be associated with poorer cognition could inform prevention programs for those who have experienced spousal bereavement.

Influencing Factors of Subjective Cognitive Impairment in Middle-Aged and Older Adults

The purpose of this study was to identify the factors affecting subjective cognitive impairment. We analyzed data from the 2019 Korea Community Health Survey and enrolled 68,546 middle-aged adults, aged 50 to 64 years, and 74,547 older adults, aged 65 years and older, in this study. Multiple logistic regression analysis was performed to identify factors influencing subjective cognitive impairment. Of the participants, 11,926 (17.4%) middle-aged and 21,880 (29.4%) older adults living in the community reported subjective cognitive impairment. Major factors that influenced subjective cognitive impairment in both middle-aged and older adults were gender, subjective stress, depressive symptoms, and alcohol drinking. In contrast to middle-aged adults, the marital status of older adults affected subjective cognitive impairment. Therefore, the factors affecting subjective cognitive impairment in middle-aged and older adults need to be considered for screening and management to prevent cognitive impairment and dementia. In particular, it is necessary to evaluate and manage stress and depressive symptoms from middle age to prevent subjective cognitive impairment.

The Association between Widowhood and Cognitive Function among Chinese Elderly People: Do Gender and Widowhood Duration Make a Difference?

Few studies have examined the effects of widowhood on cognitive function in Chinese elderly individuals. We conducted a longitudinal study to assess the association between widowhood and cognitive function and further explored gender differences in this association and the impact of widowhood duration. The analytical sample consisted of 5872 Chinese elderly people who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. We used the Chinese version of the Mini-Mental State Examination (MMSE) to assess cognitive function. Widowhood duration was calculated from the self-reported year at which the spouse passed away. Multilevel growth models were employed to estimate the association between widowhood and cognitive function while adjusting for many demographic and socioeconomic characteristics. Widowhood status was associated with cognitive decline among Chinese elderly individuals after adjusting for covariates (B = −0.440, 95% CI −0.727 to −0.152), and this association was only statistically significant among men (B = −0.722, 95% CI −1.104 to −0.339). Being widowed for 5 years or less (B = −0.606, 95% CI −1.112 to −0.100), 16–20 years (B = −0.937, 95% CI −1.685 to −0.190), and 21+ years (B = −1.401, 95% CI −1.967 to −0.834) predicted worse cognitive function in men, while being widowed for more than 21+ years (B = −0.655, 95% CI −1.186 to −0.124) was associated with cognitive decline in women. More attention should be directed towards widowed men and long-term widowed elderly individuals.

The association of marital status with cognitive function and the role of gender in Chinese community-dwelling older adults: a cross-sectional study

BACKGROUND

Evidence of the association between marital status and cognitive function in Chinese older adults is limited.

AIMS

To examine the relationship between marital status and cognitive function and to explore the role of gender amongst older adults from three Chinese communities.

METHODS

A total of 1376 participants aged 60 years or over were included in this cross-sectional study. Cognitive function was assessed using the Chinese version of the mini-mental state examination (MMSE). Marital status and other variables were collected using a standardized questionnaire. Multiple linear regression models were used to examine associations between marital statuses and cognitive function amongst the target population. The moderating role of gender in these potential associations has also been explored.

RESULTS

In univariate linear regression models, compared to being married, both being widowed (β [95% CI]: -1.46[-2.78 to - 0.13]) and being single (β [95% CI]: - 4.88[-6.43 to - 3.38]) were associated with lower MMSE scores. After adjustment for confounding factors, the significant association of being widowed with MMSE scores disappeared (β [95% CI: - 0.08[- 1.04 to 0.86]), but the association of being single with MMSE scores still existed (β [95% CI]: - 1.87[- 3.17 to - 0.58]). Furthermore, the association of being single with MMSE scores was statistically significant in men (β [95% CI]: - 5.25[- 7.17 to - 3.33]) but not in women (β [95% CI: 0.88[- 0.87 to 2.64]).

DISCUSSION AND CONCLUSIONS

Being single was associated with poorer cognitive function compared with their married counterparts in older Chinese men but not in women. More preventive measurements should be implemented for single men to reduce or delay cognitive decline. This is particularly important in the context of an aging population in China.

Associations between life course marital biography and late-life memory decline

Late-life marital status is associated with cognitive aging; however, the influence of life course marital biography (i.e., changes in marital status) on late-life cognitive trajectories, as well as gender differences in the effects of marital biography, remain to be explored. Associations between (a) marital status at study baseline (currently married, previously married, never married) and (b) retrospectively reported life course marital biography (i.e., age at first marriage, time spent unmarried following initial marriage, history of divorce, history of widowhood) and up to 20 years of subsequent episodic memory trajectories were examined using latent growth curve models in 3,061 participants aged 51 + in the Health and Retirement Study 2017 Life History Mail Survey. Gender differences were examined with multiplicative interaction terms and stratified models. Participants who were married at study baseline demonstrated higher initial memory than previously and never married individuals. Older age at first marriage and shorter duration spent unmarried were each associated with better initial episodic memory among previously married individuals only; longer duration spent unmarried was associated with slower memory decline. Stratified models suggested that these associations may be driven by women. These results highlight the importance of considering multiple aspects of marital biography, not just current marital status, in cognitive aging research. Marital biography may have an enduring influence on cognitive aging, particularly among previously married older women. Future work is needed to identify mechanisms (e.g., socioeconomic resources, cognitive stimulation, self and spousal health, emotional support) through which marital histories influence cognitive aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Marital loss and risk of dementia: Do race and gender matter?

Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.

Bayesian semi-parametric G-computation for causal inference in a cohort study with MNAR dropout and death

Causal inference with observational longitudinal data and time-varying exposures is often complicated by time-dependent confounding and attrition. The G-computation formula is one approach for estimating a causal effect in this setting. The parametric modeling approach typically used in practice relies on strong modeling assumptions for valid inference, and moreover depends on an assumption of missing at random, which is not appropriate when the missingness is missing not at random (MNAR) or due to death. In this work we develop a flexible Bayesian semi-parametric G-computation approach for assessing the causal effect on the subpopulation that would survive irrespective of exposure, in a setting with MNAR dropout. The approach is to specify models for the observed data using Bayesian additive regression trees, and then use assumptions with embedded sensitivity parameters to identify and estimate the causal effect. The proposed approach is motivated by a longitudinal cohort study on cognition, health, and aging, and we apply our approach to study the effect of becoming a widow on memory. We also compare our approach to several standard methods.

Similarities in cognitive abilities in older couples: a study of mutual influences

Objective: Similarities between spouses in cognitive functions have been mainly explained by the assortative mating phenomenon and the convergence for age and education. The mutual influence between spouses is another explanation particularly relevant in the elderly population. Today, it remains difficult to determine whether cognitive similarities exclusively result from the convergence effect or from the mutual influence. Using a novel methodology, the present study aimed to assess the impact of the marital relationship on cognitive similarities among elderly couples.Methods: 1723 couples from the Three-City Cohort Study were classified in two groups of couples with homogeneous and heterogeneous age and education. We also constituted two groups of pseudo-couples by a random association of individuals, with homogeneous and heterogeneous age and education. Dyadic analyses were conducted in the four groups, regarding the similarities in lexicosemantic abilities, executive functions, memory and global cognitive functioning.Results: Similarities were found on lexicosemantic abilities both in mate-assorted couples and in couples heterogeneous in age and education but no similarity was found in pseudo-couples.Discussion: Beyond the convergence effect, the fact that the spouses co-construct their lifestyles may contribute to cognitive similarities in the lexicosemantic domain.

Stroke disease-specific quality of life trajectories after rehabilitation discharge and their sociodemographic and clinical associations: A longitudinal, multicentre study

AIM

To investigate the longitudinal growth trajectories of disease-specific quality of life (QoL) dimensions and their associations over 1 year.

DESIGN

A longitudinal design. Data were collected between February 2015-May 2017.

METHODS

Four hundred and fifteen stroke survivors (mean age 70.6 years; 81% ischaemic stroke) were recruited after discharge from rehabilitation hospitals and were followed up every 3 months for 1 year. Changes in Stroke Impact Scale (SIS) dimension scores were evaluated using hierarchical linear models (HLMs) and linear, logarithmic, quadratic, and cubic time slope.

RESULTS

We observed a significant linear and quadratic increase in most SIS dimensions from the baseline to 12-month follow-up, especially in physical dimensions. The communication dimension was stable over time, while the memory dimension increased only linearly. Higher physical dimension scores were significantly associated with lower age, hypercholesterolaemia, and better physical functioning at baseline, while higher communication was associated with lower age, better physical functioning, and a diagnosis of peripheral vascular disease. Better memory was associated with lower age, married status, better physical functioning, and left-hemisphere stroke. Better participation was associated with lower age and better physical functioning. No significant associations were observed for emotion.

CONCLUSIONS

This study provides important information about the trajectories of stroke survivors' specific QoL and their associated variables.

IMPACT

Stroke has a great impact on stroke survivors' QoL. Disease-specific QoL significantly increases from the baseline to 12-month follow-up, especially in physical dimensions. Lower age, hypercholesterolaemia, better physical functioning, and diagnosis of peripheral vascular disease seem to be associated with better QoL. Through the analyses of associated variables, we identified stroke survivors who are more at risk and who need more tailored interventions to improve their physical, psychological, emotional, and social dimensions.

Biological and environmental predictors of heterogeneity in neurocognitive ageing: Evidence from Betula and other longitudinal studies

Individual differences in cognitive performance increase with advancing age, reflecting marked cognitive changes in some individuals along with little or no change in others. Genetic and lifestyle factors are assumed to influence cognitive performance in ageing by affecting the magnitude and extent of age-related brain changes (i.e., brain maintenance or atrophy), as well as the ability to recruit compensatory processes. The purpose of this review is to present findings from the Betula study and other longitudinal studies, with a focus on clarifying the role of key biological and environmental factors assumed to underlie individual differences in brain and cognitive ageing. We discuss the vital importance of sampling, analytic methods, consideration of non-ignorable dropout, and related issues for valid conclusions on factors that influence healthy neurocognitive ageing.

Prevalence and incidence of cognitive impairment in an elder Portuguese population (65-85 years old)

BACKGROUND

The increase in average life expectancy increases the risk of illness and frailty in the elderly, especially in the cognitive arena. This study has the objective to estimate the prevalence and incidence of cognitive impairment, in a representative sample of 65 to 85 years old followed for a mean period of 6-years.

METHODS

Subjects aged 65-85 years (n = 586) were screened at baseline (1999-2004) to estimate the prevalence of cognitive impairment using the Mini-Mental State Examination. A total of 287 individuals with a normal MMSE at baseline were reassessed after 6.2 mean years (± 4.30 years) to evaluate the incidence of cognitive impairment, defined as scoring below the age and education-adjusted MMSE cut-off points adapted for the Portuguese population. We did not exclude Dementia.

RESULTS

The baseline prevalence of cognitive impairment was 15.5% (95% CI: 12.7-18.7). Higher in women (18.9%; 95% CI: 14.9-23.3), that in men (10.4%; 95% CI: 6.7-15.1). Increased with age and was highest for participants without any schooling. The overall incidence rate was 26.97 per 1000 person-years; higher in women (33.8 per 1000 person-years) than in men (18.0 per 1000 person-years). Higher for the oldest participants and those with no schooling. Taking the standard European population, we estimated a prevalence of 16.5% and an incidence of 34.4 per 1000 person-years.

CONCLUSION

The prevalence of cognitive impairment in Portugal is within the estimated interval for the European population, and the incidence is lower than for the majority of the European countries. Women, senior and elders without education have a higher risk of cognitive impairment. In our sample, neither employment nor marital status has a significant effect on cognitive impairment.

Living arrangements and cognitive abilities of community-dwelling older adults in Singapore

AIM

Dementia is a growing public health concern. It is necessary to focus on factors that may help preserve cognitive function in late life. Limited research has examined how living arrangements are associated with cognitive function in older adults. This study aims to further our understanding of this association in community-dwelling older adults in a multi-ethnic Asian population.

METHODS

Data were obtained from a cross-sectional population survey of 2548 adults aged 60 and older with standardized instruments. Living arrangements were classified as living with adult children and grandchildren, living with adult children only, living with a spouse/partner only, living alone, living with other relatives, and living with non-relatives.

RESULTS

Cognitive function was significantly predicted by living arrangements among community-dwelling older adults. Multivariate linear regression analyses revealed that older adults in multigenerational family households had significantly poorer cognitive function than those living with a spouse/partner (β = 0.54, P < 0.02) and those living with non-relatives (β = 1.08, P < 0.02). This association was independent of the influence of age, gender, ethnicity, education, employment status, marital status, depression, disability, chronic health conditions, and self-reported health.

CONCLUSION

Older adults living in multigenerational households seem to be disadvantaged in their cognitive function. However, we cannot conclude this based on the evidence because of the cross-sectional nature of the data. Further research is needed to reasonably determine the relationship between living arrangements and cognitive function. Regardless, these findings add to the growing understanding of the complex relationship between living arrangements and cognition in older adults and could provide a basis to design effective strategies to delay cognitive decline in community-dwelling older adults.

Psychological, Cognitive, and Laboratory Characteristics of End-Stage Liver Disease Patients

Background: End-Stage Liver Disease (ESLD) causes several clinical and psychological comorbidities. Some accompanying psychiatric disturbances have significant effects on the patients’ quality of life. Objectives: Thus, we aimed to evaluate some psychological characteristics of ESLD patients. Methods: A cross-sectional study was conducted on 91 ESLD patients aged 18 - 70 years. We assessed the patients using the California Verbal Learning Test (CVLT), Fatigue Severity Scale, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Also, we measured the demographic and some laboratory data of the participants. The data were analyzed by SPSS version 21 software, and P values of less than 0.05 were considered significant. Results: The study included 68 men and 23 women with a mean age of 41.9 ± 13.72 years (range 19 - 68). The mean scores of fatigue (40.6 ± 14.8) and anxiety (12.98 ± 2.76) were more than the normal range. The most significant association was seen between age and CVLT items (attention (P = 0.01), immediate memory (P < 0.001), short delay free recall (0.01), and short delay cued recall (0.03). Conclusions: End-stage liver disease patients had anxiety, fatigue, and memory disorders in addition to their poor clinical conditions. Although the main treatment of ESLD is liver transplantation but the psychological and cognitive problems before transplantation in these patients are prognostic factors for post-operation compliance and follow up.

Spousal Loss and Change in Cognitive Functioning: An Examination of Temporal Patterns and Gender Differences

OBJECTIVES

The study investigates whether the disadvantaged position of men in the adverse consequences of widowhood for health and mortality also exists for changes in cognitive health.

METHODS

We used data of up to 1,269 men and women aged 65 years and older who participated in the Longitudinal Aging Study Amsterdam in 3-yearly assessments between 1992 and 2012 (5,123 person-observations). All were married and without cognitive impairment (Mini-Mental State Examination ≥ 24) at baseline and up to 419 lost their spouse. In fixed effects regression models, the effect of spousal loss on change in four domains of cognitive functioning was estimated independently of age-related cognitive change.

RESULTS

For women, a robust temporary decrease was found in the second year after spousal loss in the reasoning domain, but not in global cognitive functioning, processing speed, or memory. No robust effects were found for men.

DISCUSSION

Considering that only one cognitive domain was affected and effects were temporary, cognitive functioning seems rather robust to the experience of spousal loss. Despite men having often been reported to be in a disadvantaged position in other health domains, our analyses indicate no such pattern for cognitive functioning.

The power of weak ties in preserving cognitive function: a longitudinal study of older Chinese adults

Objectives: Characterized by infrequent contact, low emotional intensity, and limited intimacy, weak ties are found to be associated with better subjective well-being and other health outcomes. Drawing on the theory of weak ties and the convoy model of social relations, this paper aims to examine the association between weak ties and cognitive function among older adults in China.Methods: We used multilevel growth modeling to analyze panel data for adults aged 60 years and over (N = 2,650) selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Weak ties were measured based on the frequency of social activity participation and the number of social activities.Results: Weekly or irregular social activity participation in at least one social activity was significantly associated with better mental status and memory. The number of participated social activities was also significantly and positively associated with mental status and memory. After controlling for age, gender, marital status, educational attainment, geographic residence, household expenditures, and health conditions (i.e., depressive symptoms and self-reported health), we found that participation in a greater number of social activities protected memory from declining by 4% for every 2 years (p < 0.001).Conclusion: These findings suggest that social interactions with peripheral members of a diverse social network may help prevent cognitive decline for older Chinese adults. Greater attention on weak ties might yield practical implications for non-pharmacological dementia prevention and health promotion for the general older population.

Social network types and cognitive decline among older Korean adults: A longitudinal population-based study

OBJECTIVES

Social network (SN) has been known to impact on cognitive function in late life. However, knowledge regarding the link between SN of various types and cognitive decline (CD) is limited. This study's aim was to investigate which types of SN are associated with reduced risk of CD 2 years later among community-dwelling older adults.

METHODS

Secondary analysis of data from 1960 cognitively intact adults 65 years of age or older who participated in the Korean Longitudinal Study of Aging (KLoSA) was employed. K-means cluster analysis was conducted to derive SN types using seven common SN characteristics (marital status, living with children, number of children, frequency of contact with children, frequency of contact with friends, frequency of participation in religious activities, and frequency of participation in social groups). Multivariable linear regression analysis regarding the effects of SN type on CD between 2012 and 2014 was conducted, controlling for covariates.

RESULTS

K-means cluster analyses identified a model with five types of SN as being most optimal, and they were named diverse/couple, diverse/family, congregant, restricted/married, and widowed. The average CD 2 years later was most pronounced in those in the widowed network. Compared with the widowed, older adults in the diverse/couple network and the congregant network at baseline had a lower risk of CD 2 years after initial assessment.

CONCLUSIONS

Findings show that older Korean adults embedded in widowed network types are at risk for CD and suggest the importance of having a spouse and religious group activities in maintaining cognitive function in later life.

Trajectories of cognitive decline by widowhood status among Korean older adults

OBJECTIVES

Given the limited evidence regarding the longitudinal impact of widowhood on cognitive function in later life, the present study aimed to investigate the longitudinal effect of widowhood status on cognitive change among Korean older adults.

METHODS

The study sample was drawn from a nationally representative data set, the Korean Longitudinal Study of Ageing (KLoSA); it consisted of 3,660 Korean adults aged 60 and over who were married at baseline. Our dependent variable, cognitive function, was measured by the Korean version of the Mini-Mental State Examination (K-MMSE). Widowhood status was measured with the combination of widowhood status and duration. Growth curve models were constructed using five waves of the KLoSA (2006-2014) to examine the longitudinal trajectories of cognitive changes.

RESULTS

In the unadjusted model, widowed older adults had significantly lower cognitive function than their nonwidowed counterparts regardless of widowhood duration. Adjusting for covariates, results from the growth curve models showed that widowed older adults with widowhood duration 4 to 6 years had a significantly steeper decline in cognitive function than nonwidowed older adults (P < 0.05).

CONCLUSIONS

These findings suggest that widowhood is detrimental for late-life cognitive function. Further research is required to understand the mechanisms underlying this relationship. Policy and practice implications are discussed according to the cultural context.

Social relations and age-related change in memory

Previous research suggests that social relations are associated with age-related memory change. However, social relations are complex and multidimensional, and it is not yet clear which aspects (structure, quality) may be beneficial over time. Further, the strength and direction of associations may differ depending on relationship type (partner, children, other family, friends). Using longitudinal data from the Health and Retirement Study (n = 10,390; Mage = 69, SD = 9.53 at baseline), latent growth curve models tested which aspects of social relations predicted 6-year episodic memory trajectories. Both structure and quality of social relations were associated with initial memory level, such that being married/partnered, reporting more frequent contact with children and friends, reporting less support from family members other than partners and children, and reporting less strain across relationship types were each independently associated with better initial memory. In contrast, only structure was associated with subsequent memory decline. Specifically, being married/partnered and reporting more frequent contact with friends were each independently associated with slower memory decline. No evidence of bidirectionality was found, as baseline memory did not predict subsequent changes in social relations. This longitudinal study helps to clarify which aspects of social relations are most likely to influence late-life episodic memory trajectories. Future intervention studies may focus on increasing social interactions with nonfamily members to minimize memory decline with age. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Does widowhood affect cognitive function among Chinese older adults?

There is growing evidence from Western countries that widowhood may affect cognitive health in later life. However, little is known about whether widowhood is associated with cognitive health in Eastern Asian countries such as China and what factors may explain the association between widowhood and cognitive health. We add to this line of research by investigating the effect of widowhood on 2-year change in cognitive function among Chinese adults ages 55 and older from 2011 to 2013, using data from the China Health and Retirement Longitudinal Study. Cognitive function was measured by episodic memory and mental intactness (i.e., attention and time orientation). Our results showed that Chinese older adults who were continually widowed at both waves had significantly lower episodic memory scores at Wave 2 than their continually married counterparts, controlling for episodic memory at Wave 1, age, gender, education, and other sociodemographic variables. This suggests that the continually widowed experienced greater decline in episodic memory than the continually married over the 2-year period. After further controlling for economic resources, health, and social engagement, the difference in memory decline between the continually widowed and the continually married barely changed. The effect of widowhood on memory decline was similar for men and women. However, the continually widowed were not significantly different from the continually married in the decline of mental intactness. In addition, newly widowed adults were not significantly different from the continually married in the change of episodic memory and mental intactness. We conclude that staying widowed for 2 years or more may be an independent risk factor for episodic memory decline in China. More research is needed to investigate the mediating and moderating mechanisms underlying the association between widowhood and memory decline.

High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: A cross-sectional study

BACKGROUND

Comprehensive care given to people living with HIV/AIDS is improving over time; however, their concurrent cognitive illness is still ignored, under screened and treated particularly in developing countries. And this problem is also striking in Ethiopia. Therefore, the objective of this study was to assess HIV-associated neurocognitive disorders and associated factors among adult people living with HIV/AIDS.

METHODS

An institution based cross sectional study was conducted from April to May, 2017 at Gamo Gofa zone public Hospitals. International HIV Dementia Scale was used to screen HIV associated neurocognitive disorders. Logistic regression analysis was used to assess predictors of neurocognitive disorders.

RESULT

A total of 684 study participants were included in this study with a response rate of 98%. Among them, 56% were females while 44% were males. The mean (±SD) age of the participants was 38.8±8.8years. The screening prevalence of HIV-associated neurocognitive disorder was 67.1% (95% CI; 63.6, 70.5). Body mass index 16 kg/m2 (AOR 4.389 (1.603-12.016)), being married (AOR 0.377 (0.213-0.666), unemployment status (AOR 3.181 (1.752-5.777) and being in WHO clinical stage T3 category/advancing stages of the disease (AOR 3.558 (1.406-9.006) were the key predictors of HIV-associated neurocognitive disorders among people living with HIV/AIDS.

CONCLUSION

In this study the screening prevalence of HIV-associated neurocognitive disorder is higher than the earlier reports in Ethiopia and Africa. This indicates that early screening strategies and policies for cognitive health in people living with HIV/AIDS should be given a top priority.

How Much Do Older Adults Living Alone in Rural South Korea Know About Dementia?

OBJECTIVES

This study aimed to examine the level of dementia knowledge of older Korean adults living alone in rural areas and to identify related factors.

METHODS

A cross-sectional descriptive design was applied. The participants were 231 older adults living alone who were recruited from 12 of the 13 primary health care posts in the rural area of Chuncheon. Participants' level of dementia knowledge was assessed using the Dementia Knowledge Scale. Data were analyzed using descriptive statistics, and the t-test, analysis of variance, chi-square test, and Mann-Whitney test were applied.

RESULTS

Participants' mean age was 77.3±5.4 years, and women comprised 79.7% of the sample. Over half of the participants (61.9%) had no formal education, and all the participants were enrolled in Medical Aid. The participants' average percentage of correct answers was 61.6%. The highest rate (94.4%) was for the item "Dementia can change one's personal character." The item with the lowest proportion of correct answers was "Dementia is not treatable" (23.4%). Dementia knowledge was significantly associated with age, education, health coverage, source of living expenses, and dementia risk.

CONCLUSIONS

Dementia knowledge among Korean rural older adults living alone was relatively low. Participants' misconceptions about symptoms and treatment could hinder them from seeking early treatment. The results of this study suggest the need for active outreach and health care delivery for rural older adults living alone in South Korea.

Widowhood Status as a Risk Factor for Cognitive Decline among Older Adults

OBJECTIVES

This study investigated whether widowhood status has an effect on cognitive decline among older adults in the United States.

DESIGN

Longitudinal analysis of existing secondary data.

SETTING

The 1996-2012 waves of the Health and Retirement Study.

PARTICIPANTS

A total of 6,766 individuals (28,420 observations) aged 50 years and older who responded to all questions.

MEASUREMENTS

Widow/widower status, cognitive functioning score, and various covariates.

RESULTS

Growth-curve models show that after controlling for covariates, widowhood status was related to cognitive decline (95% CI: -0.8090, -0.4674). We also found a linear relationship between time since spousal loss and cognitive decline. Conditional upon spousal bereavement status, higher education and having at least one living sibling were found to be protective factors against cognitive decline.

CONCLUSIONS

Widowhood status accelerated cognitive decline over time among widowed older adults. Findings suggest that extra support is needed to monitor cognitive functioning for those experiencing widowhood.

Disturbed retrieval network and prospective memory decline in postpartum women

Prospective memory (PM) refers to the ability to remember to execute an intended action in the future. For successful PM performance, both top-down strategic monitoring and bottom-up spontaneous retrieval processes need to be appropriately recruited. We assessed PM performance and used fMRI to discover relevant neural correlates and possible predictors for PM performance in 25 postpartum and 26 nulliparous age- and education-matched women. Postpartum women showed decreased PM performance, a higher number of nocturnal awakenings, and lower estradiol level. The postpartum women had decreased functional connectivity (FC) in the right hippocampus and ventral frontoparietal networks (FPN) during retrieval-dominant PM trials relative to maintenance-dominant ongoing trials in the PM block. On multivariate analyses, decreased FC between the right hippocampus and ventral FPN and a higher number of nocturnal awakenings were independent predictors for poor PM performance after adjusting for age, education, estradiol level, and depressive symptoms. On mediation analyses, the estradiol level was found to have an indirect effect on PM accuracy via altered FC as a mediator. This suggests that decreased FC within the spontaneous retrieval-related regions including the right hippocampus and ventral FPN, disrupted sleep rhythms, and decreased estradiol level may contribute to poor PM performance in postpartum women.

Dietary Intake is Positively Associated with Cognitive Function of a Chinese Older Adults Sample

OBJECTIVE

The relationship between cognitive function and dietary intake in older adults was under-studied in China. This study examined this relationship in a Chinese sample while controlling for the effects of sleep quality and socio demographic confounders.

METHODS

The sample consisted of 340 Chinese older adults (age > 60) who were randomly selected from Wuhan city in central China. Cognitive function was assessed by the Mini-mental State Examination [MMSE], sleep quality by the Pittsburgh Sleep Quality Index [PSQI], and dietary intake by frequencies of intake of meat products, fruits, fish/seafood/aquatic products, nuts and mushroom/algae over the past year. First, confirmatory factor analysis (CFA) was conducted to evaluate the measurement properties of cognitive function, dietary intake, and sleep quality. Second, structural equation modeling (SEM) was conducted to examine the relations of cognitive function, dietary intake, and sleep quality.

RESULTS

Dietary intake was found to be positively related to cognitive function. Older age, lower education status, monthly income, and living alone or without a spouse were significantly associated with poorer cognitive function. SES status had an indirect effect on cognitive function via dietary intake.

CONCLUSION

Dietary intake may be critical to maintain normal cognitive function of older adults in China.

Lower cognitive performance among long-term type 1 diabetes survivors: A case-control study

OBJECTIVE

Patients with type 1 diabetes (T1D) have an increased risk of cognitive dysfunction. The cognitive decrement is believed to depend on macro- and microvascular complications and long disease duration. Some patients do not develop these complications, but still report cognitive symptoms. We examined if long-standing T1D without complications is associated with lower cognitive performance.

METHODS

A group of patients (n=43) with long-standing T1D (>30years) without micro- or macro vascular complications was compared with a non-diabetic control group (n=86) on six cognitive tests which probed episodic memory, semantic memory, episodic short-term memory, visual attention and psychomotor speed. Each patient was matched with two controls regarding age, gender and education. A linear mixed effect model was used to analyze the data.

RESULTS

The mean age was 57years and mean duration was 41years. Patients with diabetes had lower diastolic blood pressure but BMI, waist circumference, systolic blood pressure and smoking did not differ between groups. Patients had lower results than non-diabetic controls in episodic short-term memory (p<0.001) and also lower values on a test that mirrors visual attention and psychomotor speed (p=0.019).

CONCLUSIONS

Long-standing T1D was associated with lower cognitive performance, regardless of other diabetes-related complications.

On the relationship between economic conditions around the time of birth and late life cognitive abilities: Evidence from Taiwan

This study investigates the casual linkage between economic conditions around the time of birth and late life cognitive abilities. The zero-inflated negative binomial and multivariate logistic regression models were used to evaluate the direct and indirect effect of economic conditions around the time of birth on late life cognitive abilities, respectively. Both direct and indirect effects of economic conditions around the time of birth on late life cognitive abilities were identified. The relative risk ratio in adjusted mean scores of the Short Portable Mental Status Questionnaire (a means to measure cognitive impairment) indicates that being born in an economic recession year (experiencing economic recession during the year prior to birth) increases the risk of difficulties with cognition by 17.40% (11.70%). Being born in an economic recession year decreases the likelihood of high educational attainment in later life by an odds ratio of 0.962.

Social resources and cognitive ageing across 30 years: the Glostrup 1914 Cohort

BACKGROUND

to examine associations between social resources and cognitive ageing over 30 years.

METHODS

participants in the Glostrup 1914 Cohort, a year of birth sample, completed a standardarised battery of cognitive ability tests every 10 years from age 50 to 80, summarised as general cognitive ability. Participants also provided information concerning a range of social resources, including marital status and living arrangements from age 50, and from age 70, details regarding social support, social contact and loneliness.

RESULTS

across the follow-up, participants were less likely to be married, falling from 85.0 to 40.4% between ages 50 and 80, while the proportion of those living alone increased from 13.1 to 54.2%. In separate growth curve models, being married, living with others and not feeling lonely were all associated with higher cognitive ability level, while more telephone contact had a negative association. Marital status (at ages 50 and 60) and loneliness at age 70 were the only social resources associated with cognitive change; married individuals and those not feeling lonely experienced less cognitive decline. When the social resources showing significant associations were considered together (and accounting for sex, education and social class), loneliness was associated with lower cognitive ability level and greater cognitive decline, while married individuals experienced less decline.

CONCLUSIONS

in a relatively large cohort followed for up to 30 years, marital status and loneliness were associated with cognitive ability or change. Interventions designed to reduce loneliness in older adults might be supported as one avenue to reduce cognitive ageing.

Living arrangement and cognitive decline among older people in Europe

Family resources may play an important role in the wellbeing of older people. In this paper, we examine the association between living arrangement and cognitive decline among people over 65 living in different European countries. The underlined hypothesis is that living with others (i.e. spouse or/and children) vis-à-vis living alone may have a positive role in maintaining cognitive functioning, but also that such beneficial influence varies according to the circumstances. To this end, we used data from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), which provides indicators of several cognitive functions: orientation, immediate recall, delayed recall, verbal fluency and numeracy. Net of both the potential biases due to the selective attrition and the re-test effects, the evidence shows that the association between living arrangement and cognitive decline depends on the geographical area and on the starting level of cognitive function.

Marital Status, Lifestyle and Dementia: A Nationwide Survey in Taiwan

BACKGROUND

Evidence of an association between lifestyle and marital status and risk of dementia is limited in Asia.

METHODS

In this nationwide population-based cross-sectional survey, participants were selected by computerized random sampling from all 19 counties in Taiwan. A total of 10432 residents were assessed by a door-to-door in-person survey, among whom 7035 were normal and 929 were diagnosed with dementia using the criteria recommended by National Institute on Aging-Alzheimer's Association. Premorbid lifestyle habits and demographic data including marital status were compared between normal subjects and participants with dementia.

RESULTS

After adjustment for age, gender, education, body mass index, smoking, drinking, marital status, sleep habits, exercise, social engagement and co-morbidities including hypertension, diabetes and cerebrovascular diseases, an increased risk for dementia was found in people with widow or widower status (OR 1.42, 95% CI 1.15-1.77) and people who used to take a nap in the afternoon (OR 1.33, 95% CI 1.02-1.72). Decreased risk was found in people with the habit of regular exercise (OR 0.12, 95% CI 0.09-0.16), adequate night sleep (OR 0.55, 95% CI 0.39-0.76) and regular social engagement (OR 0.53, 95% CI 0.36-0.77).

CONCLUSIONS

Our results provide preliminary evidence of possible risk-reduction effects for dementia, including regular exercise even in modest amounts, social engagement and adequate night sleep, whereas people with the widow/widower status or who used to take an afternoon nap might have increased risk of dementia.

Causal inference with longitudinal outcomes and non-ignorable drop-out: Estimating the effect of living alone on cognitive decline

In this paper we develop a model to estimate the causal effect of living arrangement (living alone versus living with someone) on cognitive decline based on a 15-year prospective cohort study, where episodic memory function is measured every five years. One key feature of the model is the combination of propensity score matching to balance confounding variables between the two living arrangement groups -in order to reduce bias due to unbalanced covariates at baseline, with a pattern mixture model for longitudinal data -in order to deal with non-ignorable drop-out. A fully Bayesian approach allows us to convey the uncertainty in the estimation of the propensity score and subsequent matching in the inference of the causal effect of interest. The analysis conducted here adds to previous studies in the literature concerning the protective effect of living with someone, by proposing a modeling approach treating living arrangement as an exposure.

Mild cognitive impairment: vascular risk factors in community elderly in four cities of Hebei Province, China

Background

Evidence has demonstrated that vascular risk factors (VRFs) contribute to mild cognitive impairment (MCI) in the elderly population. Because of the race and different diagnosis standard, there is still no definitive conclusions.

Objective

To estimate the VRFs and potential protective factors for MCI in elderly population living in the community in North China.

Methods

A total of 3136 participants entered the study. They were screened for hypertension, coronary heart disease (CHD), and cerebrovascular disease (CVD). Cognitive function was assessed with Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The diagnosis of MCI was made according to Petersen’s criteria. We investigated the relationship between vascular risk factors, potential protective factors and MCI.

Results

A total of 2511 (80%) participant belonged to normal group and 625 (20%) participants showed MCI. Multiple logistic regression analysis demonstrated that stroke and diabetes, but not hypertension or CHD was associated with MCI. Besides, exercise habit could lower the risk of MCI.

Conclusions

Vascular Risk Factors, including stroke and diabetes, rather than hypertension and CHD are independent risk factors of MCI. Involvement in physical activities seems to reduce the risk of MCI.

The relationship between marital and parental status and the risk of dementia

BACKGROUND

This study examines the association between marital and parental status and their individual and combined effect on risk of dementia diseases in a population-based longitudinal study while controlling for a range of potential confounders, including social networks and exposure to stressful negative life events.

METHODS

A total of 1,609 participants without dementia, aged 65 years and over, were followed for an average period of 8.6 years (SD = 4.8). During follow-up, 354 participants were diagnosed with dementia. Cox regression was used to investigate the effect of marital and parental status on risk of dementia.

RESULTS

In univariate Cox regression models (adjusted for age as time scale), widowed (hazard ratio (HR) 1.42, 95% confidence interval (CI) = 1.13-1.78), and not having children (HR 1.54, 95% CI = 1.15-2.06) were significantly associated with incident dementia. In multivariate analyses that included simultaneously marital and parental status and covariates that were found to be significant in univariate models (p < 0.10), the HR was 1.30 (95% CI = 1.01-1.66) for widowed, and 1.51 (95% CI = 1.08-2.10) for those not having children. Finally, a group of four combined factors was constructed: married parents (reference), married without children, widowed parents, and widowed without children. The combined effect revealed a 1.3 times higher risk (95% CI = 1.03-1.76) of dementia in widow parents, and a 2.2 times higher risk (95% CI = 1.36-3.60) in widowed persons without children, in relation to married parents. No significant difference was observed for those being married and without children.

CONCLUSIONS

Our findings suggest that marital- and parental status are important risk factors for developing dementia, with especially increased risk in those being both widowed and without children.

[Factors Associated with Cognitive Decline in a Population Less than 65 Years Old. A Systematic Review]

INTRODUCTION

Cognitive decline could begin 20 years before the diagnosis of dementia. Besides age, several factors related to medical, socioeconomic, and behavioral and genetic condition may be associated with cognitive decline. The aim of this systematic review was to summarize evidence on the risk and protective factors for cognitive decline in people under 65 years old.

METHODS

A systematic review was conducted using a search strategy in MEDLINE and Embase, including longitudinal studies to analyze the effect of protective or risk factors on cognitive decline in a population under 65 years old.

RESULTS

A total of 22 studies were included in this review. Factors such as diabetes, hyperinsulinemia, overweight or obesity, metabolic syndrome, education, physical activity, cognitive stimulation, marital status and diet, could be related to cognitive decline before 65 years of age.

CONCLUSIONS

Cardiovascular risk factors and lifestyle conditions may be associated with cognitive decline before 65 years of age. However, the quality of the evidence was low.

Spousal loss and cognitive function in later life: a 25-year follow-up in the AGES-Reykjavik study

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.