Affiliations: [a]
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| [b]
Department of Pharmacology, National University of Singapore, Singapore
Correspondence:
[*]
Correspondence to: Dr. Saima Hilal, MD, PhD, Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01 Singapore 117549. Tel.: +65 6516 4988; Fax: +65 6779 1489; E-mail: saimahilal@nus.edu.sg.
Abstract: Background:Marital factor has been associated with dementia and Alzheimer’s disease, but there is limited evidence on the impact of holistic marital history over time. Objective:This study aimed to examine association of marital history with cognition. Methods:The study included 24,596 dementia-free participants from the Chinese Longitudinal Healthy Longevity Study (CLHLS). Holistic marital history was collected at baseline, categorizing participants into five groups: widow-single, widow-remarried, divorce-single, divorce-remarried and married based on the first two marriages. Dementia was collected at follow-up through self-report or from a delegate if the participant was deceased. For 15,355 participants, the Chinese Mini-Mental Status Examination (CMMSE) was administered at both baseline and follow-ups. Cognitive impairment was defined as a follow-up CMMSE score below 18, and rate of cognitive change was calculated as the change in CMMSE score between consecutive visits divided by the duration. Results:Compared with married older adults, widow-single group had significantly higher risk of dementia (HR 1.28, 95% CI 1.05, 1.54), cognitive impairment (HR 1.31, 95% CI 1.17, 1.47) and significantly faster decline of MMSE score (β –0.09, 95% CI –0.17, –0.01). Meanwhile, widow-remarried group had significantly lower risk of dementia, cognitive impairment and slower MMSE score decline than widow-single group, although the differences were only significant among female but not male. Conclusions:In this prospective cohort, married older adults and those widowed but with a second marriage had significantly better cognition than widowed individuals who did not remarry.
Keywords: Alzheimer’s disease, cognitive dysfunction, longitudinal studies, marriage, social isolation
