Regular Research ArticlesEarly Parental Death and Remarriage of Widowed Parents as Risk Factors for Alzheimer Disease: The Cache County Study
Section snippets
OBJECTIVE
Parental death during childhood is often a significant stressor affecting long-term emotional, cognitive, social, spiritual, and physical well-being. Bereaved children and adolescents are at increased risk for psychiatric disorders1 including major depression and posttraumatic stress disorder2 and alcohol or substance abuse3 after parental death. Childhood stressors such as early parental death and divorce have been shown to extend into adulthood with increased risk for poorer cardiovascular
Subjects
In 1995, we asked all permanent elderly (age 65 or older) residents of Cache County to participate in the first wave of the CCMS. A total of 5,092 participants (90%) consented. In primary analyses of AD, we excluded 294 cases of non-AD dementia, 189 subjects where cognitive status could not be determined, and 501 subjects with missing data. In a final sample of 4,108 participants, 570 were with a diagnosis of AD and 3,538 without dementia. Among the 294 subjects who were diagnosed with non-AD
RESULTS
The final sample of 4,108 participants included those experiencing early maternal death at age 0–4 years (n = 87), 5–10 years (n = 99), or 11–17 years (n = 108), whereas early paternal death included participants who experienced paternal death at age 0–4 years (n = 69), 5–10 years (n = 122), or 11–17 years (n = 174; Table 1). Subject's education, mother's and father's age at his or her birth, and AD diagnosis in late life were associated with early maternal death and early paternal death, with
DISCUSSION
In this population-based study of AD, we capitalized on a rich genealogical and vital statistics database to reexamine associations between parental death during childhood and risk of AD during late life. The use of the vital statistics data base removed recall bias as a potential confound. Mother's death during offspring adolescence was uniquely associated with more than double the risk of AD, with attenuated effects if the widowed father remarried, with equivalent correlations for sons and
CONCLUSION
The present study provides further evidence that the traumatic event of parental death during childhood is associated with higher rates of AD in late life. Of particular note is the finding that the strength of association between mother's or father's death and AD depends on timing within childhood during the parent's death and that effects are stronger when the widowed parent does not remarry. This finding extends our prior work by demonstrating that this association is specific to AD and
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This work was supported by National Institute of Health grants: AG-031272, AG-011380, and AG-021136. Partial support for all data sets within the Utah Population Database (UPDB) was provided by the University of Utah Huntsman Cancer Institute and the Huntsman Cancer Institute Cancer Center Support grant, P30 CA42014 from National Cancer Institute. The authors thank the following individuals whose activities have helped to ensure the success of the project: Cara Brewer, B.A., Tony Calvert, B.S.C., Carol Leslie, M.S., Georgiann Sanborn, M.S., Michelle Mc. Cart., Heidi Wengreen, Ph.D., R.D., James Wyatt, and Peter P. Zandi, Ph.D., M.P.H., Roxane Pfister, M.S., and Nancy Sassano, Ph.D.
Neuropsychological testing and clinical assessment procedures were developed by Dr. Welsh-Bohmer and Dr. Breitner. Dr. Tschanz provided training and oversight of all field staff and reviewed all individual neuropsychological test results to render professional diagnoses. The board-certified or board-eligible geriatric psychiatrists or neurologists who examined the study members included Drs. Steinberg, Breitner, Steffens, Lyketsos, Gagliardi, Raj, Christopher, and Green. Dr. Williams also examined several subjects and provided expert neurologic consultation. Autopsy examinations were conducted by Dr. Townsend. Ms. Leslie coordinated the autopsy enrollment program. Diagnosticians at the expert consensus conferences included Drs Breitner, Burke, Lyketsos, Plassman, Steffens, Steinberg, Toohill, Tschanz, and Welsh-Bohmer.
Drs. Norton, Breitner, Corcoran, Smith, Tschanz, Østbye, and Ms. Schwartz have no disclosures. Dr. Skoog got research funding from the Swedish Research Council, Swedish Council for Working Life and Social Research, The Alzheimer's Association. Dr. Steffens got travel support from Bristol-Myers Squibb to present at a scientific meeting and grant support from the National Institute of Mental Health.