The loss when Losing a Loved one: Epidemiological studies of prolonged grief disorder

Objective
The most common serious adverse life event is the experience of the death of a significant person. The reaction is grief, but some persons will find difficult to deal with the loss and will show symptoms of a complicated and unresolved grief, termed prolonged grief disorder (PGD). This thesis investigated the associations between PGD and different domains of cognition and brain volumes assessed by MRI in a middle-aged and elderly population. Also, were compared the cognitive decline, morning cortisol and summary cortisol measures and sleep quality and sleep duration between persons with PGD and a reference group. Additionally, the association of non-clinical cerebral small vessel disease with depression was tested.
Methods
The current study is embedded in the Rotterdam Study. Participants were classified as experiencing no grief, normal grief or prolonged grief disorder, as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (MMSE, LDST, Stroop Test, WFT, WLT immediate and delayed recall). GM, WM, WMLs, SBIs, lacunar infarcts, cerebral microbleeds and general brain parameters, were measure with brain magnetic resonance. Sleep was assessed with the Pittsburgh Sleep Quality Index. Saliva samples were collected to measure cortisol levels.
Results
Participants with PGD performed poorly in letter digit test and Word fluency task, and had smaller total volumes of brain matter, compared with reference group. Participants with PGD also showed a stronger cognitive decline than reference group during 7 years of follow-up. PGD was associated cross-sectionally with shorter sleep duration and lower sleep quality, but longitudinally was not associations. PGD participants showed low levels of morning cortisol and low overall diurnal cortisol levels when compared with normal grievers. An increased risk of recurrent depression was associated with silent brain infarcts. WML volumes and lacunar infarcts were associated with depressive symptoms and disorders. Cerebral microbleeds were related to depressive symptoms only.
Conclusions
The findings suggest that there may be a neurological correlate of PGD, and that PGD is a risk factor for cognitive decline. The cross-sectional associations of PGD with a shorter sleep duration and a lower sleep quality were mainly explained by depressive symptoms. PGD participants showed low levels of morning cortisol and low overall diurnal cortisol levels characteristic for a chronic stress reaction. The results indicate that WMLs and lacunar infarcts might be non-specific vascular lesions seen in depressive symptoms and disorders. The association of microbleeds with more severe forms of depression may indicated impaired brain iron homeostasis or minor episodes of cerebrovascular extraversion.