Stress regulation as a link between executive function and pre-frailty in older adults

Abstract

Objectives Both pre-frailty and frailty are linked with impaired executive function (EF) but the mechanism underlying this relationship is not known. Williams and colleagues’ model posits EF affects health outcomes via stress regulation. This model was utlized to test indicators of stress regulation as mediators of the relationship between EF and pre-frailty in older adults. Design Cross-sectional. Setting Academic general clinical research centers. Participants 690 community-dwelling older adults ≥ 50 years of age. Measurements Pre-frailty was measured using a modified form of the Fried Frailty measure. EF was assessed via telephone-based neurocognitive assessments. Indicators of stress regulation included: stress exposure (measured by perceived stress), reactivity and recovery (measured by heart rate) and restoration (measured by serum interleukin-6 and sleep quality). Results 396 individuals were classified as non-frail, 277 as pre-frail, and 17 as frail. Pre-frail and non-frail individuals were included in data analyses. Compared to non-frail individuals, prefrail were older and exhibited poorer EF, higher levels of stress exposure and poorer stress restoration. Poorer EF was associated with greater stress exposure, less stress reactivity, longer stress recovery and poorer stress restoration. The total effect of the relationship between EF and pre-frailty was significant with significant indirect effects supporting stress exposure and restoration as mediators of the relationship. Conclusion Stress exposure and restoration appear to mediate the relationship between EF and pre-frailty. Longitudinal studies are needed to clarify the direction of causality and determine whether stress regulation processes are appropriate targets for interventions aiming to prevent declines in EF and the development of pre-frailty.

Effects of Acute Laboratory Stress on Executive Functions

“…For exploratory reasons, we also calculate the interaction of age and stress on executive performance. Old age shows adverse effects on executive functioning (review in Harada et al, 2013 ) and a recent study demonstrated that stress exposure and executive functioning were negatively related in older adults ( Roiland et al, 2015 ).…”

Precipitous Dehydroepiandrosterone Declines Reflect Decreased Physical Vitality and Function

“…A previous paper on renal function in these MIDUS participants found a significant age-related decline in glomerular filtration rate, but there were no individuals with Stage 4 or 5 Chronic Kidney Disease (41). Similarly, a recent study exploring executive function and indicators of frailty in 690 MIDUS participants, who were 50 years of age or older, found that only 17 met the frailty criteria posited by the Fried Frailty measure (42). Thus, despite multiple tests of physical functioning confirming age-related declines in performance (21,22,24), future research is needed to demonstrate that DHEA would be a robust correlate among already frail individuals.…”

Executive Functioning and Health

“…Given the associations between EF and PNS functioning described heretofore, it is hypothesized that EF should predict physiological recovery from stressful events. Although evidence for this association is limited, preliminary research suggests that poorer EF is associated with longer heart-rate-recovery times from stress among older adults (Roiland, Lin, Phelan, & Chapman, 2015).…”