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

Published online by Cambridge University Press:  03 November 2014

H. C. Saavedra Pérez ,
M. A. Ikram ,
N. Direk ,
H. G. Prigerson ,
R. Freak-Poli ,
B. F. J. Verhaaren ,
A. Hofman ,
M. Vernooij  and
H. Tiemeier
H. C. Saavedra Pérez
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
M. A. Ikram
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
N. Direk
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
H. G. Prigerson
Affiliation:
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA Harvard Medical School, Center for Psychosocial Epidemiology and Outcomes Research, Boston, MA, USA Center for Psycho-Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
R. Freak-Poli
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
B. F. J. Verhaaren
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
A. Hofman
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
M. Vernooij
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
H. Tiemeier*
Affiliation:
Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
*
* Address for correspondence: H. Tiemeier, M.D., Ph.D., Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands. (Email: h.tiemeier@erasmusmc.nl)
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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.

Keywords

Brain lesionscognitive performancecognitive testscomplicated griefnormal griefstructural brain volumes
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 7 , May 2015 , pp. 1389 - 1399
Copyright
Copyright © Cambridge University Press 2014 

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References

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, 231–235.Google Scholar
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, 444–452.Google Scholar
Boelen, PA, Prigerson, HG (2012). Commentary on the inclusion of persistent complex bereavement-related disorder in DSM-5. Death Studies 36, 771–794.Google Scholar
Corruble, E, Falissard, B, Gorwood, P (2011). DSM bereavement exclusion for major depression and objective cognitive impairment. Journal of Affective Disorders 130, 113–117.Google Scholar
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, 1151–1161.Google Scholar
Elliot, R (2003). Executive functions and their disorders. Imaging neuroscience: clinical frontiers for diagnosis and management. British Medical Bulletin 65, 49–59.Google Scholar
Funahashi, S (2001). Neuronal mechanisms of executive control by the prefrontal cortex. Neuroscience Research 39, 147–165.Google Scholar
Ginzburg, K, Geron, Y, Solomon, Z (2002). Patterns of complicated grief among bereaved parents. Omega: Journal of Death and Dying 45, 119–132.Google Scholar
Hardison, HG, Neimeyer, RA, Lichstein, KL (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral Sleep Medicine 3, 99–111.Google Scholar
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, 157–168.Google Scholar
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, 657–686.Google Scholar
Horowitz, MJ, Siegel, B, Holen, A, Bonanno, GA, Milbrath, C, Stinson, CH (1997). Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry 154, 904–910.Google Scholar
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, 811–824.Google Scholar
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, 882–890.Google Scholar
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, 5870–5876.Google Scholar
Lezak, MD, Howieson, DB, Loring, DW (2004). Neuropsychological Assessment, 4th edn. Oxford University Press: New York.Google Scholar
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, 1394–1401.Google Scholar
Maccallum, F, Bryant, RA (2010). Attentional bias in complicated grief. Journal of Affective Disorders 125, 316–322.CrossRefGoogle ScholarPubMed
Mitchell, AM, Kim, Y, Prigerson, HG, Mortimer-Stephens, M (2004). Complicated grief in survivors of suicide. Crisis 25, 12–18.Google Scholar
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, 339–343.CrossRefGoogle Scholar
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, 669–680.Google Scholar
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, 231–238.Google Scholar
Ochsner, KN, Gross, JJ (2005). The cognitive control of emotion. Trends in Cognitive Sciences 9, 242–249.Google Scholar
O'Connor, M (2012). Immunological and neuroimaging biomarkers of complicated grief. Dialogues in Clinical Neuroscience 14, 141–148.Google Scholar
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, 12–18.Google Scholar
Ott, CH (2003). The impact of complicated grief on mental and physical health at various points in the bereavement process. Death Studies 27, 249–272.Google Scholar
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, 307–310.Google Scholar
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, 143–151.Google Scholar
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, 470–476.Google Scholar
Posner, MI, Rothbart, MK (2007). Research on attention networks as a model for the integration of psychological science. Annual Review of Psychology 58, 1–23.Google Scholar
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, 391–395.Google Scholar
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, 65–79.Google Scholar
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, 2034–2041.Google Scholar
Reeve, WV, Schnadler, SL (2001). Frontal lobe functioning in adolescents with attention deficit hyperactivity disorder. Adolescence 36, 749–765.Google Scholar
Romanowski, CA, Wilkinson, ID (2011). Atrophy: when too much atrophy is too little brain. Neuroradiology 53, 133–139.Google Scholar
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, 257–269.Google Scholar
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, 421–428.Google Scholar
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, 2601–2608.Google Scholar
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, 103–117.Google Scholar
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, 168–177.Google Scholar
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, 194–207.Google Scholar
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, 363–374.Google Scholar
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, 998–1009.Google Scholar
van Hoof, JJ, Lezak, MD (1995). Neuropsychological Assessment, 3rd edn. Oxford University Press: New York.Google Scholar
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, 545–553.Google Scholar
Ward, L, Mathias, JL, Hitchings, SE (2007). Relationships between bereavement and cognitive functioning in older adults. Gerontology 53, 362–372.Google Scholar
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, 589–593.Google Scholar
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, 294–301.Google Scholar
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, 205–211.Google Scholar