Marital status and incident screen-positive cognitive impairment in a Taiwanese longitudinal cohort (2005–2016): Associations vary by cognitive screening instrument
4 affiliations
- 1Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
- 2Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
- 3School of Medicine, National Defense Medical University, Taipei, Taiwan
- 4Department of Family Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan
Abstract
Marital status has been associated with cognitive aging; however, whether such associations vary according to cognitive assessment modality remains unclear. This study examined whether associations between marital status and incident screen-positive cognitive impairment (MCI) differ by screening instrument and population subgroups in a large longitudinal cohort of community-dwelling older adults in Taiwan. We analyzed 103,863 adults aged ≥65 years from the Taipei City Elderly Health Examination Database (2005–2016). Cognitive status was assessed using the Short Portable Mental Status Questionnaire (SPMSQ; 2005–2011) and the 8-item Ascertain Dementia questionnaire (AD8; 2012–2016). Baseline marital status was categorized as married, divorced, widowed, or never married. Cox proportional hazards models with time-updated covariates were fitted separately for each assessment period, adjusting for demographic, socioeconomic, health, and lifestyle factors. Sensitivity analyses were conducted to examine potential reverse causation and variation in follow-up duration. Among 61,304 participants assessed during the SPMSQ period, never-married individuals had a higher risk of incident MCI compared with married individuals (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.08–1.74). In contrast, among 42,559 participants assessed during the AD8 period, never-married status was associated with a lower risk of MCI (HR 0.60, 95% CI 0.46–0.77). Effect modification by sex and age was observed across periods. Sensitivity analyses yielded consistent findings. Associations between marital status and incident MCI differed across assessment periods that varied in screening instrument, follow-up duration, and population composition; this measurement heterogeneity, rather than a confirmed temporal change, may account for the reversal observed among never-married participants. These findings suggest that interpretation of marital status–cognition associations should be considered alongside the measurement approach and study period under which they were derived.
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BibTeX
@article{zhou2026marital,
title = {{Marital status and incident screen-positive cognitive impairment in a Taiwanese longitudinal cohort (2005–2016): Associations vary by cognitive screening instrument}},
author = {Yi-Chao Zhou and Yi-Chang Chou and Yin-Ling Hung and Yen-Jung Chang},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359778},
url = {https://doi.org/10.1371/journal.pone.0359778},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Marital status and incident screen-positive cognitive impairment in a Taiwanese longitudinal cohort (2005–2016): Associations vary by cognitive screening instrument
AU - Yi-Chao Zhou
AU - Yi-Chang Chou
AU - Yin-Ling Hung
AU - Yen-Jung Chang
PY - 2026
DA - 2026/10/05
JO - PLOS One
DO - 10.1371/journal.pone.0359778
UR - https://doi.org/10.1371/journal.pone.0359778
AB - Marital status has been associated with cognitive aging; however, whether such associations vary according to cognitive assessment modality remains unclear. This study examined whether associations between marital status and incident screen-positive cognitive impairment (MCI) differ by screening instrument and population subgroups in a large longitudinal cohort of community-dwelling older adults in Taiwan. We analyzed 103,863 adults aged ≥65 years from the Taipei City Elderly Health Examination Database (2005–2016). Cognitive status was assessed using the Short Portable Mental Status Questionnaire (SPMSQ; 2005–2011) and the 8-item Ascertain Dementia questionnaire (AD8; 2012–2016). Baseline marital status was categorized as married, divorced, widowed, or never married. Cox proportional hazards models with time-updated covariates were fitted separately for each assessment period, adjusting for demographic, socioeconomic, health, and lifestyle factors. Sensitivity analyses were conducted to examine potential reverse causation and variation in follow-up duration. Among 61,304 participants assessed during the SPMSQ period, never-married individuals had a higher risk of incident MCI compared with married individuals (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.08–1.74). In contrast, among 42,559 participants assessed during the AD8 period, never-married status was associated with a lower risk of MCI (HR 0.60, 95% CI 0.46–0.77). Effect modification by sex and age was observed across periods. Sensitivity analyses yielded consistent findings. Associations between marital status and incident MCI differed across assessment periods that varied in screening instrument, follow-up duration, and population composition; this measurement heterogeneity, rather than a confirmed temporal change, may account for the reversal observed among never-married participants. These findings suggest that interpretation of marital status–cognition associations should be considered alongside the measurement approach and study period under which they were derived.
SN - 1932-6203
ER -