Older married couples demonstrate domain-specific cognitive concordance 

1. In this cross-sectional study, older Korean spouses demonstrated significant concordance in verbal fluency, constructional praxis, naming, and constructional recall.

2. No significant spousal concordance was observed in global cognition.

Evidence Rating Level:  2 (Good)

Study Rundown: Previous research has shown that spouses often experience similar trajectories of cognitive aging; however, whether this concordance varies across cognitive domains remains unclear. This cross-sectional study conducted in Korea aimed to determine whether cognitive concordance among older married couples is domain specific or reflects a global phenomenon while accounting for potential demographic and genetic confounders. The study included married couples and an equal number of matched control pairs. Using a four-group matched design, each spouse was matched with an unrelated control based on sex, age, education, cognitive diagnosis, and apolipoprotein E ε4 status. Participants completed the Korean version of the Consortium to Establish a Registry for Alzheimer Disease neuropsychological assessment battery, which comprises nine cognitive subtests. After correction for multiple comparisons, significant spousal concordance, defined as the difference between the intraclass correlation coefficients of real and matched control couples, was observed on four tests: Verbal Fluency, Constructional Praxis, the Boston Naming Test, and Constructional Recall. These tests primarily assess language and visuospatial abilities. Conversely, no meaningful excess concordance was observed in global cognition, assessed using the Mini-Mental State Examination, or in verbal memory recall and recognition. Study limitations included its cross-sectional design, which could not distinguish assortative mating from cognitive convergence over time; limited generalizability beyond older Korean adults; exploratory comparisons with heritability estimates derived from non-Korean populations; and limited information about marriage duration, cohabitation, and other shared exposures. Nonetheless, the findings suggest that cognitive concordance among older married couples may be domain specific and could be overlooked on global cognitive screening measures.

Click here to read the study in JAMA Network Open

Relevant Reading: Occurrence and Risk Factors for Cognitive Decline Shared by Couples: A Systematic Review and Meta-Analysis

In-Depth [cross-sectional study]: This nationwide, multicentre study used data from the Korean Longitudinal Study of Cognitive Aging and Dementia to compare cognitive performance within actual couples against that of matched unrelated pairs. Community-dwelling adults aged 60 years or older were recruited from 13 Korean districts. Eligible couples were legally married, and both spouses were required to have completed the fourth follow-up assessment between January 2019 and December 2020. Couples without complete data for all nine cognitive subtests and adjustment covariates were excluded. The final sample included 783 married couples, comprising 1,566 individuals, of whom 783 (50.0%) were female. Participants had a mean age of 74.0 years (standard deviation [SD], 5.5 years). Each spouse was matched without replacement to an unrelated control based on sex, cognitive diagnosis, and apolipoprotein E ε4 status, as well as age and education within two years. This process produced 783 independent matched control pairs. Spousal concordance was defined as the difference between the intraclass correlation coefficients (ICCs) of actual and matched control couples. Following false discovery rate correction, significant concordance was identified on 4 of 9 tests. In unadjusted analyses, these were Verbal Fluency (ICC difference, 0.232; 95% CI, 0.138-0.324), Constructional Praxis (0.145; 95% confidence interval [CI], 0.039-0.252), the Boston Naming Test (0.134; 95% CI, 0.038-0.231), and Constructional Recall (0.110; 95% CI, 0.017-0.200). All four remained significant after full adjustment: Verbal Fluency (ICC difference, 0.208; 95% CI, 0.111-0.304; P<.001), Constructional Praxis (0.200; 95% CI, 0.089-0.309; P<.001), Boston Naming Test (0.226; 95% CI, 0.127–0.325; P<.001), and Constructional Recall (0.138; 95% CI, 0.044-0.231; P=.003). Concordance was not significant for global cognition (ICC difference, 0.034; P=.33), Word List Recall (0.008; P=.44), or Word List Recognition (0.028; P=.36). These results indicate that cognitive concordance among older spouses is concentrated in language and visuospatial abilities rather than global cognition.

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