Skip to main content
×
×
Home

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

  • H. C. Saavedra Pérez (a1), M. A. Ikram (a1) (a2), N. Direk (a1), H. G. Prigerson (a3) (a4) (a5), R. Freak-Poli (a1) (a6), B. F. J. Verhaaren (a1) (a2), A. Hofman (a1), M. Vernooij (a1) (a2) and H. Tiemeier (a1) (a7) (a8)...
Abstract
Background

Several psychosocial risk factors for complicated grief have been described. However, the association of complicated grief with cognitive and biological risk factors is unclear. The present study examined whether complicated grief and normal grief are related to cognitive performance or structural brain volumes in a large population-based study.

Method

The present research comprised cross-sectional analyses embedded in the Rotterdam Study. The study included 5501 non-demented persons. Participants were classified as experiencing no grief (n = 4731), normal grief (n = 615) or complicated grief (n = 155) as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (Mini-Mental State Examination, Letter–Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test – immediate and delayed recall), and magnetic resonance imaging to measure general brain parameters (white matter, gray matter), and white matter lesions. Total brain volume was defined as the sum of gray matter plus normal white matter and white matter lesion volume. Persons with depressive disorders were excluded and analyses were adjusted for depressive symptoms.

Results

Compared with no-grief participants, participants with complicated grief had lower scores for the Letter–Digit Substitution Test [Z-score −0.16 v. 0.04, 95% confidence interval (CI) −0.36 to −0.04, p = 0.01] and Word Fluency Task (Z-score −0.15 v. 0.03, 95% CI −0.35 to −0.02, p = 0.02) and smaller total volumes of brain matter (933.53 ml v. 952.42 ml, 95% CI −37.6 to −0.10, p = 0.04).

Conclusions

Participants with complicated grief performed poorly in cognitive tests and had a smaller total brain volume. Although the effect sizes were small, these findings suggest that there may be a neurological correlate of complicated grief, but not of normal grief, in the general population.

Copyright
Corresponding author
* Address for correspondence: H. Tiemeier, M.D., Ph.D., Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. (Email: h.tiemeier@erasmusmc.nl)
References
Hide All
Beekman, AT, Deeg, DJ, Van Limbeek, J, Braam, AW, De Vries, MZ, Van Tilburg, W (1997). Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychological Medicine 27, 231235.
Boelen, PA, Prigerson, HG (2007). The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults: a prospective study. European Archives of Psychiatry and Clinical Neuroscience 257, 444452.
Boelen, PA, Prigerson, HG (2012). Commentary on the inclusion of persistent complex bereavement-related disorder in DSM-5. Death Studies 36, 771794.
Corruble, E, Falissard, B, Gorwood, P (2011). DSM bereavement exclusion for major depression and objective cognitive impairment. Journal of Affective Disorders 130, 113117.
de Boer, R, Vrooman, HA, van der Lijn, F, Vernooij, MW, Ikram, MA, van der Lugt, A, Breteler, MM, Niessen, WJ (2009). White matter lesion extension to automatic brain tissue segmentation on MRI. Neuroimage 45, 11511161.
Elliot, R (2003). Executive functions and their disorders. Imaging neuroscience: clinical frontiers for diagnosis and management. British Medical Bulletin 65, 4959.
Funahashi, S (2001). Neuronal mechanisms of executive control by the prefrontal cortex. Neuroscience Research 39, 147165.
Ginzburg, K, Geron, Y, Solomon, Z (2002). Patterns of complicated grief among bereaved parents. Omega: Journal of Death and Dying 45, 119132.
Hardison, HG, Neimeyer, RA, Lichstein, KL (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral Sleep Medicine 3, 99111.
Hek, K, Tiemeier, H, Newson, RS, Luijendijk, HJ, Hofman, A, Mulder, CL (2011). Anxiety disorders and comorbid depression in community dwelling older adults. International Journal of Methods in Psychiatric Research 3, 157168.
Hofman, A, van Duijn, CM, Franco, OH, Ikram, MA, Janssen, HL, Klaver, CC, Kuipers, EJ, Nijsten, TE, Stricker, BH, Tiemeier, H, Uitterlinden, AG, Vernooij, MW, Witteman, JC (2011). The Rotterdam Study: 2012 objectives and design update. European Journal of Epidemiology 26, 657686.
Horowitz, MJ, Siegel, B, Holen, A, Bonanno, GA, Milbrath, C, Stinson, CH (1997). Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry 154, 904910.
Ikram, MA, van der Lugt, A, Niessen, WJ, Krestin, GP, Koudstaal, PJ, Hofman, A, Breteler, MM, Vernooij, MW (2011). The Rotterdam Scan Study: design and update up to 2012. European Journal of Epidemiology 26, 811824.
Ikram, MA, Vrooman, HA, Vernooij, MW, van der Lijn, F, Hofman, A, van der Lugt, A, Niessen, WJ, Breteler, MM (2008). Brain tissue volumes in the general elderly population. The Rotterdam Scan Study. Neurobiology of Aging 6, 882890.
Lannen, PK, Wolfe, J, Prigerson, HG, Onelov, E, Kreicbergs, UC (2008). Unresolved grief in a national sample of bereaved parents: impaired mental and physical health 4 to 9 years later. Journal of Clinical Oncology 26, 58705876.
Lezak, MD, Howieson, DB, Loring, DW (2004). Neuropsychological Assessment, 4th edn. Oxford University Press: New York.
Luijendijk, HJ, van den Berg, JF, Dekker, MJ, van Tuijl, HR, Otte, W, Smit, F, Hofman, A, Stricker, BH, Tiemeier, H (2008). Incidence and recurrence of late-life depression. Archives of General Psychiatry 65, 13941401.
Maccallum, F, Bryant, RA (2010). Attentional bias in complicated grief. Journal of Affective Disorders 125, 316322.
Mitchell, AM, Kim, Y, Prigerson, HG, Mortimer-Stephens, M (2004). Complicated grief in survivors of suicide. Crisis 25, 1218.
Natu, MV, Agarwal, AK (2002). Digit Letter Substitution Test (DLST) as an alternative to Digit Symbol Substitution Test (DSST). Human Psychopharmacology Clinical and Experimental 10, 339343.
Nelson, SM, Dosenbach, NU, Cohen, AL, Wheeler, ME, Schlaggar, BL, Petersen, SE (2010). Role of the anterior insula in task-level control and focal attention. Brain Structure and Function 214, 669680.
Newson, RS, Boelen, PA, Hek, K, Hofman, A, Tiemeier, H (2011). The prevalence and characteristics of complicated grief in older adults. Journal of Affective Disorders 132, 231238.
Ochsner, KN, Gross, JJ (2005). The cognitive control of emotion. Trends in Cognitive Sciences 9, 242249.
O'Connor, M (2012). Immunological and neuroimaging biomarkers of complicated grief. Dialogues in Clinical Neuroscience 14, 141148.
O'Connor, MF, Arizmendi, BJ (2014). Neuropsychological correlates of complicated grief in older spousally bereaved adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 69, 1218.
Ott, CH (2003). The impact of complicated grief on mental and physical health at various points in the bereavement process. Death Studies 27, 249272.
Pasternak, RE, Reynolds, CF III, Schlernitzauer, M, Hoch, CC, Buysse, DJ, Houck, PR, Perel, JM (1991). Acute open-trial nortriptyline therapy of bereavement-related depression in late life. Journal of Clinical Psychiatry 52, 307310.
Pearson, JM, Heilbronner, SR, Barack, DL, Hayden, BY, Platt, ML (2011). Posterior cingulate cortex: adapting behavior to a changing world. Trends in Cognitive Sciences 15, 143151.
Pihlajamäki, M, Tanila, H, Hänninen, T, Könönen, M, Laakso, M, Partanen, K, Soininen, H, Aronen, HJ (2000). Verbal fluency activates the left medial temporal lobe: a functional magnetic resonance imaging study. Annals of Neurology 47, 470476.
Posner, MI, Rothbart, MK (2007). Research on attention networks as a model for the integration of psychological science. Annual Review of Psychology 58, 123.
Posner, MI, Rothbart, MK, Sheese, BE, Tang, Y (2007). The anterior cingulate gyrus and the mechanism of self-regulation. Cognitive, Affective, and Behavioral Neuroscience 7, 391395.
Prigerson, HG, Maciejewski, PK, Reynolds, CF III, Bierhals, AJ, Newsom, JT, Fasiczka, A, Frank, E, Doman, J, Miller, M (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Neuroimaging Psychiatry Research 59, 6579.
Prins, ND, van Dijk, EJ, den Heijer, T, Vermeer, SE, Jolles, J, Koudstaal, PJ, Hofman, A, Breteler, MM (2005). Cerebral small-vessel disease and decline information processing speed, executive function and memory. Brain 128, 20342041.
Reeve, WV, Schnadler, SL (2001). Frontal lobe functioning in adolescents with attention deficit hyperactivity disorder. Adolescence 36, 749765.
Romanowski, CA, Wilkinson, ID (2011). Atrophy: when too much atrophy is too little brain. Neuroradiology 53, 133139.
Rosnick, CB, Small, BJ, Burton, AM (2010). The effect of spousal bereavement on cognitive functioning in a sample of older adults. Neuropsychology, Development, and Cognition 17, 257269.
Rozenzweig, A, Prigerson, H, Miller, MD, Reynolds, CF III (1997). Bereavement and late-life depression: grief and its complications in the elderly. Annual Review of Medicine 48, 421428.
Shear, K, Frank, E, Houck, PR, Reynolds, CF III (2005). Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association 293, 26012608.
Shear, MK, Simon, N, Wall, M, Zisook, S, Neimeyer, R, Duan, N, Reynolds, C, Lebowitz, B, Sung, S, Ghesquiere, A, Gorscak, B, Clayton, P, Ito, M, Nakajima, S, Konishi, T, Melhem, N, Meert, K, Schiff, M, O'Connor, MF, First, M, Sareen, J, Bolton, J, Skritskaya, N, Mancini, AD, Keshaviah, A (2011). Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety 28, 103117.
Shimada, H, Kato, T, Ito, K, Makizako, H, Doi, T, Yoshida, D, Shimokata, H, Washimi, Y, Endo, H, Suzuki, T (2012). Relationship between atrophy of the medial temporal areas and cognitive functions in elderly adults with mild cognitive impairment. European Neurology 67, 168177.
Szanto, K, Prigerson, H, Houck, P, Ehrenpreis, L, Reynolds, CF III (1997). Suicidal ideation in elderly bereaved: the role of complicated grief. Suicide and Life-Threatening Behavior 27, 194207.
Tata, DA, Marciano, VA, Anderson, BJ (2006). Synapse loss from chronically elevated glucocorticoids: relationship to neuropil volume and cell number in hippocampal area CA3. Journal of Comparative Neurology 498, 363374.
Vander Elst, W, van Boxtel, MP, van Breukelen, GJ, Jolles, J (2006). The Letter Digit Substitution Test: normative data for 1,858 healthy participants aged 24–81 from the Maastricht Aging Study (MAAS): influence of age, education, and sex. Journal of Clinical and Experimental Neuropsychology 28, 9981009.
van Hoof, JJ, Lezak, MD (1995). Neuropsychological Assessment, 3rd edn. Oxford University Press: New York.
Vernooij, MW, Ikram, MA, Vrooman, HA, Wielopolski, PA, Krestin, GP, Hofman, A, Niessen, WJ, Van der Lugt, A, Breteler, MM (2009). White matter microstructural integrity and cognitive function in a general elderly population. Archives of General Psychiatry 66, 545553.
Ward, L, Mathias, JL, Hitchings, SE (2007). Relationships between bereavement and cognitive functioning in older adults. Gerontology 53, 362372.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.
Xavier, FM, Ferraz, MP, Trentini, CM, Freitas, NK, Moriguchi, EH (2002). Bereavement-related cognitive impairment in an oldest-old community-dwelling Brazilian sample. Journal of Clinical and Experimental Neuropsychology 24, 294301.
Zuckoff, A, Shear, K, Frank, E, Daley, DC, Seligman, K, Silowash, R (2006). Treating complicated grief and substance use disorders: a pilot study. Journal of Substance Abuse Treatment 30, 205211.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score