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Stress Linked With Cognitive Decline in Older US Adults
An association was found between stress and cognitive impairment in Black and White US adults over the age of 45 by researchers from Emory University, Atlanta, Georgia. Results were published online in JAMA Network Open.
“This cohort study suggests that increased levels of perceived stress are associated with both prevalent cognitive impairment and [incident cognitive impairment (ICI)] and that the association does not vary by age, race, and sex,” lead researcher Ambar Kulshreshtha, MD, PhD, Emory University, Atlanta, Georgia, and co-authors wrote. “Findings from our study could have important clinical applications, such as regular screening for stress among high-risk older adults when they present with cognitive decline in primary care.”
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Study participants were sourced from the national population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of 30,239 Black and White US adults aged 45 years or older from 2003 to 2007. Researchers collected data using telephone appointments, self-administered questionnaires, and in-home examinations. Perceived stress was assessed with the 4-item version of the Cohen Perceived Stress Scale once at baseline and once during follow-up. Researchers used the Six-Item Screener (SIS) to evaluate participants’ cognitive function. Those with a score under 5 were considered to have cognitive impairment. ICI was defined as a shift from intact cognition (SIS score >4) at baseline to impaired cognition (SIS score ≤4) at the most recent assessment.
In total, 24,448 participants, 59.9% women, with a median age of 64 years, and 41.6% Black, were included in the results. Elevated stress levels were reported by 5589 (22.9%) participants and associated with 1.37 times higher odds of poor cognition, even after adjustment for demographic information, lifestyle, and cardiovascular risk factors, and depression (adjusted odds ratio, 1.37; 95% CI, 1.22-1.53). The connection between the Perceived Stress Scale score with incident cognitive impairment was significant in both the unadjusted model (OR, 1.62; 95% CI, 1.46-1.80) and after adjustment (AOR, 1.39; 95% CI, 1.22-1.58).
Higher perceived stress was more likely to be found in those who:
• were younger;
• were female;
• were Black;
• didn’t have a college degree;
• had a lower family income ;
• lived in the southeastern US states, where rates of stroke are highest;
• were less physically active; and
• were more frequent smokers.
Cardiovascular risk factors like hypertension, diabetes, and dyslipidemia were also more likely to be found in in those with elevated stress levels.
Authors noted that because the participation rate in the REGARDS study was 49%, it could have limited generalizability of the study findings. They also acknowledged that reverse causality could explain some of the findings, though it was less likely “given that our study is longitudinal and perceived stress was associated with ICI.”
“More research is needed to explore the underlying mechanisms for this observed association and to develop screening programs and targeted interventions to reduce stress among older adults at risk of cognitive impairment,” authors concluded.
