- Unmarried people in a U.S. study had a lower risk of dementia than married people.
- The study followed 24,000 older adults through the National Alzheimer's Coordinating Center.
- Findings were similar for men and women.
Unmarried people had a lower risk of dementia than those who were married, data from an 18-year cohort study of 24,000 older adults suggested.
In models adjusted for age and sex, never-married (HR 0.60, 95% CI 0.52-0.71), divorced (HR 0.66, 95% CI 0.59-0.73), and widowed older adults (HR 0.73, 95% CI 0.67-0.79) had less dementia risk than married adults, reported Selin Karakose, PhD, of the Florida State University College of Medicine in Tallahassee, and co-authors.
All unmarried groups also had a lower risk of progression from mild cognitive impairment to dementia, the researchers wrote in Alzheimer's & Dementia. Findings were similar for men and women and were significant for Alzheimer's disease and Lewy body dementia.
Participants had annual evaluations at specialized dementia clinics. The study findings may indicate delayed diagnoses among unmarried people or could question the assumption that marriage protects against dementia.
"Contrary to expectations and challenging the commonly held belief that marriage is protective against cognitive decline and dementia, this study found that married older adults exhibited a higher risk of dementia compared to those never married, divorced, and widowed," Karakose said.
"This finding can change the way we understand the connection between marital status and risk of dementia," she told MedPage Today. "Previous work has emphasized the benefits of marriage. However, married individuals may have a smaller social network, tend to be less self-reliant, and may experience stressful conditions such as caregiving, which could contribute to the risk of dementia."
One of the first analyses to evaluate dementia by marital status in the U.S. used data from the Health and Retirement Study from 2000 to 2014. That study showed that unmarried individuals had significantly higher odds of developing dementia than their married counterparts.
The current study evaluated data from the National Alzheimer's Coordinating Center (NACC), an ongoing longitudinal study of participants recruited from Alzheimer's Disease Research Centers throughout the U.S. At each annual visit, clinicians assessed cognitive status using neuropsychological tests and clinical examinations. Dementia diagnoses were based on the Clinical Dementia Rating scale.
The analysis included data up to June 2024 and was based on 24,107 individuals without dementia at baseline. Mean age was 71.79 years, 59.6% were female, and 79.9% were white.
Participants were classified as married (15,409 people), widowed (3,939 people), divorced (3,360 people), or never married (1,339 people). Due to small numbers, those who were separated were included in the divorced group, and those living with a domestic partner were included in the married group.
Over a median of 3.97 years, 4,853 participants developed dementia: 3,729 had Alzheimer's disease, 341 had Lewy body dementia, 246 had vascular dementia, and 184 had frontotemporal dementia.
Of the four marital status groups, widowed participants had an older baseline age (mean age 78.32) compared with married (mean age 70.73), divorced (mean age 70.11), and never married (mean age 69.14) individuals. Relationships between marital status and dementia were attenuated but remained significant in fully adjusted models for divorced (HR 0.83, 95% CI 0.72-0.96) and never married (HR 0.76, 95% CI 0.62-0.93) individuals, but not for widowed (HR 0.90, 95% CI 0.79-1.03) participants.
A supplemental analysis that examined participants whose relationships changed over the course of the study found that those who experienced widowhood during the follow-up period had a lower risk of dementia than those who remained continuously married.
The study had several limitations, Karakose and colleagues said. It included voluntary NACC participants who may not represent the U.S. population; most of the sample was white and married. Factors like financial stress and social connections may have played a role and were not accounted for in the analysis.
In addition, "examining the association through duration of post-marital life, including transitions to divorce, with the role of relationship factors (e.g., marital quality, relationship duration) may provide a more nuanced understanding than a simple binary effect," the researchers pointed out.
Disclosures
The National Alzheimer's Coordinating Center (NACC) database is funded by the National Institute on Aging (NIA). NACC data are contributed by the NIA-funded Alzheimer's Disease Research Centers.
Karakose and co-authors reported no disclosures.
Primary Source
Alzheimer's & Dementia
Source Reference: Karakose S, et al "Marital status and risk of dementia over 18 years: surprising findings from the National Alzheimer's Coordinating Center" Alzheimer's Dement 2025; DOI: 10.1002/alz.70072.
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