Bereavement-Related Cognitive Impairment in an Oldest-Old Community-Dwelling Brazilian Sample

Abstract

As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke-Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of 'aging-associated cognitive decline' when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause-effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.

Does the “Widowhood Effect” Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults

“…We additionally examine a range of outcomes previously associated with widowhood including mental health (19,20), cognitive health (21), and physical health markers, such as mobility and instrumental activities of daily living (22); we examine these outcomes both before and after spousal bereavement to inform several mechanistic pathways simultaneously. Determining the cause and mechanism of the “widowhood effect” is important for the development of interventions to alleviate excess mortality.…”

Neuropsychological Correlates of Complicated Grief in Older Spousally Bereaved Adults

“…In individuals aged 65-80, widow(er) hood is an independent predictor of cognitive decline, even when controlling for physical functioning and depressive symptoms (Aartsen, Van Tilburg, Smits, Comijs, & Knipscheer, 2005). Neuropsychological functioning in bereaved individuals aged 80-95, compared with a matched nonbereaved sample (Xavier, Ferraz, Trentini, Freitas, & Moriguchi, 2002), showed that bereavement was longitudinally associated with worsened cognitive performance, specifically involving attention and memory. This decreased performance could not be explained by greater symptoms of depression.…”

Cognition, structural brain changes and complicated grief. A population-based study

“…Our study underscores the importance of assessing social, neuropsychological and biological factors that may underlie the occurrence of complicated grief or may result from prolonged exposure to a normal grief reaction. The neuropsychological differences between persons with and without complicated grief were more modest than in clinical studies (Xavier et al 2002;Ward et al 2007;Maccallum & Bryant, 2010;Rosnick et al 2010;Corruble et al 2011;O'Connor & Arizmendi, 2014). Thus, any clinical implications must be inferred cautiously.…”

“…Compared with either normal-grief or no-grief groups, participants with complicated grief performed worse in domains of executive function, and information processing speed, and had a lower total brain volume as measured by structural brain imaging. The few previous studies of bereavement and cognition demonstrated poorer memory performance and attention in persons with normal grief, but did not specifically examine complicated grief (Xavier et al 2002;Ward et al 2007;Rosnick et al 2010;Corruble et al 2011). Two other studies examined the emotional Stroop Test in persons with complicated grief, demonstrating that participants have more cognitive interference compared with no-complicated-grief participants (Maccallum & Bryant, 2010;O'Connor & Arizmendi, 2014).…”