Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
Department of Pharmacology, National University of Singapore, Singapore.
J Alzheimers Dis. 2024;100(2):675-683. doi: 10.3233/JAD-240176.
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.
This study aimed to examine association of marital history with cognition.
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.
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.
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.
婚姻因素与痴呆和阿尔茨海默病有关，但关于整体婚姻史随时间变化的影响的证据有限。
本研究旨在研究婚姻史与认知之间的关系。
本研究纳入了 24596 名无痴呆的中国长寿纵向研究（CLHLS）参与者。整体婚姻史在基线时收集，根据前两次婚姻将参与者分为五组：丧偶-单身、丧偶-再婚、离婚-单身、离婚-再婚和已婚。痴呆症通过随访时的自我报告或已故参与者的代表收集。对于 15355 名参与者，在基线和随访时均进行了中国简易精神状态检查（CMMSE）。认知障碍定义为随访时 CMMSE 评分低于 18 分，认知变化率计算为两次连续就诊时 CMMSE 评分的变化除以间隔时间。
与已婚的老年人相比，丧偶-单身组患痴呆症（HR 1.28，95%CI 1.05，1.54）、认知障碍（HR 1.31，95%CI 1.17，1.47）和认知功能明显下降（β-0.09，95%CI-0.17，-0.01）的风险更高。同时，与丧偶-单身组相比，丧偶-再婚组患痴呆症、认知障碍和认知功能下降速度较慢的风险显著降低，尽管差异仅在女性中显著，而在男性中不显著。
在这项前瞻性队列研究中，与丧偶且未再婚的老年人相比，已婚的老年人和丧偶后再婚的老年人认知功能明显更好。
