Association of Stress With Cognitive Function Among Older Black and White US Adults

Abstract

ImportancePerceived stress can have long-term physiological and psychological consequences and has shown to be a modifiable risk factor for Alzheimer disease and related dementias.ObjectiveTo investigate the association between perceived stress and cognitive impairment in a large cohort study of Black and White participants aged 45 years or older.Design, Setting, and ParticipantsThe Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national population-based cohort of 30 239 Black and White participants aged 45 years or older, sampled from the US population. Participants were recruited from 2003 to 2007, with ongoing annual follow-up. Data were collected by telephone, self-administered questionnaires, and an in-home examination. Statistical analysis was performed from May 2021 to March 2022.ExposuresPerceived stress was measured using the 4-item version of the Cohen Perceived Stress Scale. It was assessed at the baseline visit and during 1 follow-up visit.Main Outcomes and MeasuresCognitive function was assessed with the Six-Item Screener (SIS); participants with a score below 5 were considered to have cognitive impairment. Incident cognitive impairment was defined as a shift from intact cognition (SIS score >4) at the first assessment to impaired cognition (SIS score ≤4) at the latest available assessment.ResultsThe final analytical sample included 24 448 participants (14 646 women [59.9%]; median age, 64 years [range, 45-98 years]; 10 177 Black participants [41.6%] and 14 271 White participants [58.4%]). A total of 5589 participants (22.9%) reported elevated levels of stress. Elevated levels of perceived stress (dichotomized as low stress vs elevated stress) were associated with 1.37 times higher odds of poor cognition after adjustment for sociodemographic variables, cardiovascular risk factors, and depression (adjusted odds ratio [AOR], 1.37; 95% CI, 1.22-1.53). The association of the change in 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 for sociodemographic variables, cardiovascular risk factors, and depression (AOR, 1.39; 95% CI, 1.22-1.58). There was no interaction with age, race, and sex.Conclusions and RelevanceThis study suggests that there is an independent association between perceived stress and both prevalent and incident cognitive impairment. The findings suggest the need for regular screening and targeted interventions for stress among older adults.

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“…Chronic stress has been widely recognized as a risk factor in the pathogenesis of mood disorders (Charney & Manji, 2004; Wang et al, 2021) and is associated with cognitive decline (Carrier et al, 2021; Kulshreshtha et al, 2023). However, much less is known about how impaired cognition and altered brain plasticity, such as observed in VDD mice, could affect sensitivity to chronic stress.…”

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“…21) Previous studies have shown that perceived stress is associated with lower cognitive scores and a faster rate of cognitive decline in older adults. 22,23) Kulshreshtha et al 2) showed that elevated levels of perceived stress (dichotomized as low stress vs elevated stress) were associated with 1.37 times higher odds of poor cognition after adjustment for sociodemographic variables, cardiovascular risk factors, and depression (adjusted odds ratio [AOR], 1.37; 95% CI, 1.22-1.53). In line with this study, two previous studies in Korea investigating the association between resilience and cognitive impairment also a correlation between resilience and overall cognitive function in a middleaged Korean population.…”

“…Stress has been suggested as a modifiable factor of Alzheimer's disease. Perceived stress, defined as a consequence of events or demands that exceed an individual's professed ability to cope, 2) can have longterm physiological and psychological consequences, and has been shown to be a modifiable risk factor for mild cognitive impairment and Alzheimer's disease. 3,4) Chronic or prolonged stress can have damaging effects on various brain functions by differing ways, including tau and amyloid accumulation and prolonged secretion of glucocorticoids via hypothalamus-pituitary-adrenal cortex axis activation.…”

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“…Depression is a prevalent disorder often precipitated by chronic stress, which not only causes mood disturbances but also impairs cognitive function [1]. Accumulating evidence indicates that experiencing stressful events affects cognitive function [2,3] and that perceived stress levels are associated with cognitive impairment in humans [4]. In a preclinical study, chronic stress exposure in rodents resulted in depression-like behavior and a decline in cognitive function [5].…”