Marriage May Protect Against Dementia - 7/30/08

[Smartmarriages]

ICAD: Marriage May Protect Against Dementia
By Todd Neale, Staff Writer, MedPage Today
July 30, 2008

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine,
University of California, San Francisco

CHICAGO, July 30 -- The give and take of marriage may be enough to stave off
Alzheimer's disease and other cognitive impairment, a prospective
population-based study suggested.

People living alone from midlife on were almost three times as likely to
develop some level of cognitive impairment as those who were living with a
partner Krister Hakansson, of Vaxjo University in Vaxjo, Sweden, and the
Karolinska Institute in Stockholm, reported at the International Conference
on Alzheimer's Disease here.

There were similar greater risks of mild cognitive impairment, and
Alzheimer's disease for those living alone.

"This study points to the beneficial effects of a married life," Hakansson
said, "consistent with the general hypothesis of social stimulation as a
protective factor against dementia."

It has been suggested that remaining socially active may protect against the
development of dementia, and Hakansson reasoned that a partner relationship
would form the most intense form of social interaction because of the
necessity of dealing with another's needs or perspectives, enhanced
communication, and joint problem-solving.

So he and colleagues turned to the Cardiovascular Risk Factors, Aging, and
Dementia (CAIDE) study, which randomly selected middle-age participants from
the general population of Finland. Baseline measurements were taken from
1972 to 1987.

In 1998, after a mean follow-up of 21 years, 1,432 of the participants ages
65 to 79 were evaluated for signs of cognitive impairment. At baseline,
1,147 were married or cohabitating, 111 were single, 63 were separated or
divorced, and 111 were widowed.

At the end of follow-up, 139 were diagnosed with some form of cognitive
impairment, including 82 with mild cognitive impairment -- which may
represent a transitional phase between normal age-related memory decline and
Alzheimer's disease -- and 48 with Alzheimer's.

Those who were not living with a partner at midlife were twice as likely to
have some level of cognitive impairment or mild cognitive impairment later
in life than those who were married or cohabitating, regardless of their
late-life living status.

The association with an increased risk of Alzheimer's disease did not reach
statistical significance.

Widowed participants at midlife who did not remarry had the highest
increased risk of any cognitive impairment, mild cognitive impairment, and
Alzheimer's disease later in life.

Having the APOE-e4 genotype -- a risk factor for Alzheimer's -- was
particularly damaging for those who were widowed or divorced from midlife
through late life. Those who were married and had the high-risk genotype had
a 3.44-fold increased risk of Alzheimer's disease, compared with a
25.55-fold greater risk for those who were divorced or widowed.

This suggested, Hakansson said, that other factors beyond cohabitation were
involved in the associations.

All analyses were adjusted for education, body mass index, cholesterol,
blood pressure, occupation, physical activity, smoking habits, and
depression at midlife, as well as APOE e4 status, age at follow-up, and
gender.

Hakansson speculated that those who were widowed or divorced -- and remained
so -- were at a greater risk than those who were single because the loss of
a partner destabilized the psychobiological system, enhancing vulnerability
to disease.

- ACTION POINTS:

    * Explain to interested patients that this study found that living alone
in midlife was associated with a higher risk of cognitive impairment later
in life.

    * Point out that the epidemiological study could not establish
causality.

    * Note that this study was published as an abstract and presented orally
at a conference. These data and conclusions should be considered to be
preliminary until published in a peer-reviewed journal.

For article and stats:
http://www.medpagetoday.com/MeetingCoverage/ICAD/tb/10334

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