Association between mid-life marital status and cognitive function in later life: population based cohort study.
Association between mid-life marital status and cognitive function in later life: population based cohort study.
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中期婚姻状况与后来生活的认知功能之间的关联：基于人群的队列研究。
DOI：
10.1136/bmj.b2462
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发表时间：
2009-07-02
期刊：
影响因子：
--
通讯作者：
Kivipelto M
中科院分区：
文献类型：
--
作者：
Håkansson K;Rovio S;Helkala EL;Vilska AR;Winblad B;Soininen H;Nissinen A;Mohammed AH;Kivipelto M
目的探讨中年婚姻状况与晚年认知功能的关系。设计以人群为基础的前瞻性研究，平均随访21年。位于芬兰东部的库奥皮奥和若恩苏地区。参与者来自之前在1972、1977、1982或1987年调查的随机、基于总体的样本；1449名(73%)年龄在65-79岁的人在1998年接受了重新检查。主要结果衡量阿尔茨海默病和轻度认知障碍。结果在中年与伴侣同居的人(平均年龄50.4岁)在65-79岁的晚年表现出认知障碍的可能性低于所有其他类别(单身、分居或丧偶)。与已婚或同居的人相比，那些在中年丧偶或离婚并在后续行动中仍然如此的人的风险是前者的三倍。与已婚或同居的人相比，那些在中年和晚年丧偶的人患阿尔茨海默氏症的赔率为7.67(1.6比40.0)。阿尔茨海默病风险最高的是载脂蛋白E e4等位基因携带者，他们在中年前失去伴侣，在随访时仍是寡妇或离婚。从中年开始逐步进入的几个调整变量并没有改变这些联系。结论：与伴侣生活在一起可能意味着认知和社交挑战，这与大脑储备假说一致，对晚年的认知障碍具有保护作用。与单身人士相比，寡妇和离婚者的风险明显增加，这表明还需要其他因素来解释部分结果。一种社会遗传疾病模型可能解释了寡居载脂蛋白E e4携带者患阿尔茨海默病风险急剧增加的原因。
Objectives To evaluate whether mid-life marital status is related to cognitive function in later life. Design Prospective population based study with an average follow-up of 21 years. Setting Kuopio and Joensuu regions in eastern Finland. Participants Participants were derived from random, population based samples previously investigated in 1972, 1977, 1982, or 1987; 1449 individuals (73%), aged 65-79, underwent re-examination in 1998. Main outcome measures Alzheimer’s disease and mild cognitive impairment. Results People cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79. Those widowed or divorced in mid-life and still so at follow-up had three times the risk compared with married or cohabiting people. Those widowed both at mid-life and later life had an odds ratio of 7.67 (1.6 to 40.0) for Alzheimer’s disease compared with married or cohabiting people. The highest increased risk for Alzheimer’s disease was in carriers of the apolipoprotein E e4 allele who lost their partner before mid-life and were still widowed or divorced at follow-up. The progressive entering of several adjustment variables from mid-life did not alter these associations. Conclusions Living in a relationship with a partner might imply cognitive and social challenges that have a protective effect against cognitive impairment later in life, consistent with the brain reserve hypothesis. The specific increased risk for widowed and divorced people compared with single people indicates that other factors are needed to explain parts of the results. A sociogenetic disease model might explain the dramatic increase in risk of Alzheimer’s disease for widowed apolipoprotein E e4 carriers.
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