乌鸦传媒

Perceived stress was linked with both prevalent and incident cognitive impairment in older adults, data from a national longitudinal cohort study showed.

Elevated levels of perceived stress -- dichotomized as low versus high stress scores -- were associated with higher odds of poor cognition after adjusting for sociodemographic variables, cardiovascular risk factors, and depression (adjusted OR 1.37, 95% CI 1.22-1.53), according to Ambar Kulshreshtha, MD, PhD, of Emory University School of Medicine in Atlanta, and co-authors.

Similarly, high stress levels were associated with incident cognitive impairment (adjusted OR 1.39, 95% CI 1.22-1.58), the researchers reported in . There was no interaction with age, race, or sex.

In the cohort of 24,448 people with a median age of 64, a total of 5,589 people (22.9%) reported high levels of stress.

"Perceived stress is common among older adults, and it has been previously associated with accelerated aging, heart disease, and reduced immunity," Kulshreshtha noted.

"Our research in a large longitudinal study shows that perceived stress can be associated with cognitive decline," he told 乌鸦传媒. "Given that there are very limited treatment options for dementia, research on how we can prevent this condition by addressing modifiable risk factors such as stress is critical."

Clinicians should screen for high levels of stress in older adults, Kulshreshtha added. "Brief questionnaires like the Perceived Stress Scale can be readily deployed in clinical practice," he said. "Even asking one question routinely -- how do you manage your stress? -- can be very helpful for patients to open up and discuss this common condition."

A study in Finland recently suggested that dementia risk was higher in people who had signs of stress and anxiety earlier in life. Other research tied patterns of repeated rumination or worry with subsequent declines in global cognition, immediate memory, and delayed memory.

Perceived stress occurs when demands exceed a person's professed ability to cope and has been linked with hormonal and inflammatory indicators of accelerated aging and excess cardiovascular morbidity and mortality risks, Kulshreshtha and colleagues noted.

"Perceived stress, especially in racial and ethnic minority groups, can directly affect cognition and also plays a role in worsening of unhealthy behaviors, such as smoking, physical inactivity, and reduced medication compliance," the team observed.

Kulshreshtha and co-authors evaluated participants in the study of Black and white Americans 45 or older. REGARDS participants were recruited from 2003 to 2007 and had annual follow-up. Data were collected by phone calls, self-administered questionnaires, and in-home exams.

The researchers measured stress with the 4-item version of the (PSS) at baseline and during one follow-up visit. Scores on the PSS range from 0-16; a score of 5 or more was considered high.

The (SIS) was used to assess cognitive function. Scores range from 0 to 6, and participants with an SIS score below 5 were considered to have cognitive impairment. Incident cognitive impairment was defined as a shift from intact cognition (SIS score of 5 or 6) at the first assessment to impaired cognition (score of 4 or less) at the most recent one.

The sample included 41.6% Black and 58.4% white participants. Most participants (59.9%) were women.

Participants with higher perceived stress scores were more likely to be younger, female, and Black, less likely to have a college degree, and had lower family income. They more frequently had cardiovascular disease risk factors such as hypertension, diabetes, and dyslipidemia. They were less physically active, had a higher body mass index, and more often were current smokers.

"While eliminating stress is not always possible, clinicians can help people develop healthier responses to stress using approaches such as mindfulness, a healthier lifestyle including physical activity and good sleep, and counseling," Kulshreshtha said.

Stress and depressive symptoms in this study were measured with validated but abbreviated versions of lengthier questionnaires, the researchers acknowledged. Unmeasured confounders could potentially explain associations between stress and cognition. Reverse causality could, too, but that was less likely given that the study was longitudinal and a clear dose response was seen between perceived stress and worse cognitive impairment, the team added.

Comment