Widowhood, Alzheimer's disease biomarker linked to cognitive decline among older adults

Widowhood may accelerate cognitive decline and Alzheimer’s disease clinical progression, according to a study published in JAMA Network Open.

“Being a widow compared with being married was associated with steeper cognitive decline independent of other known risk factors for cognitive decline,” Nancy J. Donovan, MD, director of the division of geriatric psychiatry at Brigham and Women’s Hospital, told Healio Psychiatry. “Being widowed rather than married had a compounding effect on cognitive decline associated with brain amyloid. This suggests that widowed individuals are at particular risk for faster decline in early Alzheimer’s disease and merit specific research attention.”

Prior research has shown a rising incidence of clinical impairment due to Alzheimer’s disease. According to Donovan and colleagues, defining older adults at highest risk is essential to mitigate this rise, and widowhood may be an unrecognized factor contributing to the faster progression along the Alzheimer’s disease pathway among older adults without cognitive impairment.

Donovan and colleagues collected data of 257 community-dwelling, cognitively unimpaired older adults (mean age, 73.5 years; 59.5% women) with higher levels of brain beta-amyloid. One hundred forty-five (56.4%) were married, 77 (30%) were unmarried and 35 (13.6%) were widowed. Researchers evaluated all participants at four study visits using the Preclinical Alzheimer Cognitive Composite (PACC), assessed socioeconomic status using the Two-Factor Hollingshead score, and assessed social engagement and emotional support using responses to questionnaires.

Results showed that in the first mixed-effects model, cognitive performance on PACC declined in the widowed group and differed significantly compared with the married group (beta = 0.11; 95% CI, 0.19 to 0.04) with no differences between the married and unmarried groups. In the second main model, beta-amyloid-associated PACC decline in the widowed group appeared steeper compared with the married group (beta = 0.22; 95% CI, 0.42 to 0.03), with no difference between the married and unmarried groups. Widowed individuals with high beta-amyloid experienced cognitive decline at a rate three times faster than that of married individuals with high beta-amyloid, independent of depression, socioeconomic status, age and sex, the researchers noted. Both the risk for widowhood and risk for Alzheimer’s disease rose as age increased, particularly among women.

“Going forward, it will be very important to determine the biological processes and other factors that explain the connection between widowhood and cognitive decline,” Donovan said. “This will allow us to develop targeted interventions for this high-risk group.” – by Erin T. Welsh

Disclosures: Donovan reports receiving research salary support from Eli Lilly and Co and Eisai and serving on the advisory board for Avanir Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.