Cognitive decline may happen faster in widowed adults than married ones.

Mark Beaumont MD

January 12, 2022



Alzheimer disease (AD) is a global public health challenge, a condition affecting approximately 50 million men and women worldwide and is projected to triple in prevalence by 2050. To reduce the number of cases and consequences of AD, it is essential to recognize risk factors for this condition and furthermore develop preventive treatments for older adults at high risk of AD-related cognitive decline.

A recent study in JAMA has shown that losing a spouse or significant other may speed up the cognitive decline often associated with Alzheimer’s. Over a three-year period, cognitive abilities, which include the mechanisms of how we learn, remember, problem-solve, and pay attention, declined three times faster in widowed adults with high levels of beta-amyloid compared to married people with equally high levels. Beta amyloid is a protein present in the brain tissue of those with Alzheimer’s and is a marker that may indicate increased risk for the disease. Even for those without beta-amyloid accumulation in the brain and no signs of cognitive decline, the risk for dementia and memory loss was greater for men and women who were widowed.

Widowhood has been independently associated with declines in memory performance and an increased risk of dementia. Using data from the U.S Health and Retirement Study, researchers evaluated more than 6,000 married older adults and observed significantly greater cognitive decline among those who became widowed compared with those who did not, adjusting for age, race/ethnicity, sex, education, depression, other health conditions and behaviors, spouse’s medical status before death, and remarriage. 

Differences in cognitive performance were significant 2 years after spousal loss and worsened with longer duration of widowhood. Another comprehensive study found that widowed men and women had a 20% greater risk of developing dementia compared with married persons during 3 to 15 years of follow-up.

According to a 2016 US Census Bureau report, more than 34% of American women and 11% of men ages 65 years or older are widowed. Women are more likely to survive a spouse than men. US census data shows that 43% of widows between 75 and 84 years and 72% of widows 85 years or older are women, compared to 15% and 35% of men. 

Widowhood is an underrecognized and neglected risk factor associated with Alzheimer’s-related cognitive decline and impairment. The underlying mechanisms and relationship are not well understood. Alzheimer’s disease is not caused by one single element or circumstance and its’ natural progression and severity can be impacted by a combination of life style habits, such as diet, exercise, medical conditions, such as, cardiovascular disease, genetics and the environment where one lives.

The next step toward improving cognitive outcomes in widowers at risk for AD should be encouraging greater attention toward the types of interventions, support and resources that could maintain brain health which include eating a brain healthy diet, getting regular exercise and having healthy social interactions. More research still needs to be performed to further investigate how these factors relate to each other and anyone at risk for AD should discuss these points with their primary care physician.

Alzheimer disease is biologically defined by the presence of brain deposits of β-amyloid and tau pathologies, which initially accumulate while individuals have no cognitive impairment.8,9 Approximately 25% of cognitively unimpaired adults aged 60 years or older have elevated levels of β-amyloid, as detected by positron emission tomography (PET), and are 2 to 5 times more likely to progress to clinical impairment (ie, mild cognitive impairment or dementia) than those with low β-amyloid levels during 3 to 4 years of follow-up.10,11 Increased but variable rates of progression to clinical impairment among individuals with high β-amyloid levels suggest the importance of identifying other biological and clinical factors that might explain the heterogeneity of cognitive outcomes. At the same time, understanding the contribution of β-amyloid to cognitive outcomes in specific at-risk populations, such as widowed older adults, is also clinically important.

In this study, we evaluated short-term changes in cognitive performance among cognitively unimpaired, widowed older adults compared with their married counterparts and whether rates of cognitive change were further influenced by β-amyloid levels. We hypothesized an interactive association of widowhood and β-amyloid with cognition in which widowhood would be associated with worsening cognition compared with the married group, independent of age, sex, socioeconomic status, depression, and baseline β-amyloid levels, and rates of cognitive change would be accelerated among those with higher levels of β-amyloid. In secondary analyses, we tested whether the association of widowhood and cognitive change was independent of several biological, behavioral, and social support factors.