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Marriage and risk of dementia: systematic review and meta-analysis of observational studies
Sommerlad A, Ruegger J, Singh-Manoux A, Lewis G, Livingston G.. Journal of neurology, neurosurgery, and psychiatry, 2017-11-28
Topic: Risk, prevention and care in population studies
Background Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors. We conducted a systematic review and meta-analysis of studies of the association between marital status and the risk of developing dementia. Methods We searched medical databases and contacted experts in the field for relevant studies reporting the relationship, adjusted for age and sex, between marital status and dementia. We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married. Secondary stratified analyses with meta-regression examined the impact of clinical and social context and study methodology on findings. Results We included 15 studies with 812 047 participants. Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia. We did not find an association in divorced people.Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people. Compared with studies that used clinical registers for ascertaining dementia diagnoses, those which clinically examined all participants found higher risk for being unmarried. Conclusions Being married is associated with reduced risk of dementia than widowed and lifelong single people, who are also underdiagnosed in routine clinical practice. Dementia prevention in unmarried people should focus on education and physical health and should consider the possible effect of social engagement as a modifiable risk factor.
Key findings
- Background Being married is associated with healthier lifestyle behaviours and lower mortality and may reduce risk for dementia due to life-course factors.
- We rated methodological quality and conducted random-effects meta-analyses to summarise relative risks of being widowed, divorced or lifelong single, compared with being married.
- Results We included 15 studies with 812 047 participants.
- Compared with those who are married, lifelong single (relative risk=1.42 (95% CI 1.07 to 1.90)) and widowed (1.20 (1.02 to 1.41)) people have elevated risk of dementia.
- We did not find an association in divorced people.Further analyses showed that less education partially confounds the risk in widowhood and worse physical health the elevated risk in lifelong single people.
Why it matters
Pooling 15 observational studies with 812,047 people, this review found that lifelong single people (relative risk 1.42) and widowed people (1.20) had a higher dementia risk than married people; divorced people showed no difference. Lower education partly explained the widowhood link and poorer physical health the single-person link, and unmarried people also appeared to be underdiagnosed in routine care. The authors suggest prevention for unmarried people focus on education and physical health — an association, not proof that marriage itself protects.
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Study details
- Study designsystematic review
- Participants15
- Evidence strengthHigh
How this study scored 71/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of neurology, neurosurgery, and psychiatry) |
| Journal's citation record | 3 / 4 | Journal of Neurology Neurosurgery & Psychiatry: journal h-index 336 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2018 — within 10 year(s) of the newest study here |
| Sample size | 1 / 4 | 15 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 5 / 7 | Cited 252 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 25.2 citations a year over 10 year(s) since 2018 |
| Impact for its field and year | 3 / 6 | Cited 3.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 11 other studies in this library |
| Still being cited | 3 / 4 | Cited 93 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Gill Livingston: h-index 99 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University College London: institution h-index 2,029 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 29183957) |
| Free to read | 2 / 2 | Free to read |
| Total | 71 / 100 | — |
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Read the original
- DOI: 10.1136/jnnp-2017-316274
- PubMed: 29183957
- Original source →
- Free full text: Journal of Neurology Neurosurgery & Psychiatry →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Sommerlad, A., Ruegger, J., Singh-Manoux, A., Lewis, G., & Livingston, G. (2018). Marriage and risk of dementia: systematic review and meta-analysis of observational studies. Journal of neurology, neurosurgery, and psychiatry. https://doi.org/10.1136/jnnp-2017-316274
Vancouver
Sommerlad A, Ruegger J, Singh-Manoux A, Lewis G, Livingston G. Marriage and risk of dementia: systematic review and meta-analysis of observational studies. Journal of neurology, neurosurgery, and psychiatry. 2018. doi:10.1136/jnnp-2017-316274. PMID: 29183957.
BibTeX
@article{sommerlad2018-29183957,
author = {Sommerlad, A. and Ruegger, J. and Singh-Manoux, A. and Lewis, G. and Livingston, G.},
title = {{Marriage and risk of dementia: systematic review and meta-analysis of observational studies}},
journal = {Journal of neurology, neurosurgery, and psychiatry},
year = {2018},
doi = {10.1136/jnnp-2017-316274},
pmid = {29183957},
url = {https://doi.org/10.1136/jnnp-2017-316274}
}
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