Increased levels of perceived stress may be linked to poor cognition

According to a study published in Open JAMA Network. In long-term follow-up, incident cognitive impairment (ICI) – defined as a change from intact cognition to impaired cognition from the first to the last assessment – ​​was also associated with perceived stress.

“Understanding the association between perceived stress and cognitive functioning in different subgroups is important for designing targeted interventions and could have important implications for public health,” the study authors wrote.

Not only is perceived stress associated with poor cognitive function, but perceived stress may be a precursor to poor cognition, according to the study. Perceived stress can have lasting effects on physiological and psychological functions.

It is a modifiable risk factor that can lead to cognitive impairment, Alzheimer’s disease, accelerated aging, reduced cardiovascular health, and is associated with sleep problems and immune dysfunction. Perceived stress can also worsen unhealthy behaviors, such as smoking and physical activity.

“Perceived stress is defined as a consequence of events or demands that exceed an individual’s reported ability to cope,” the study authors wrote. “Perceived stress can have long-term physiological and psychological consequences and has been shown to be a modifiable risk factor for mild cognitive impairment and Alzheimer’s disease. Perceived stress in adults is associated with hormonal and inflammatory indicators of accelerated aging as well as an excess risk of cardiovascular morbidity and mortality and stroke. It has also been linked to sleep problems and poor immune function.

Stress related to low socioeconomic status and discrimination may contribute to higher incidence of dementia in racial and ethnic minority groups; however, there are few long-term studies investigating stress and cognitive impairment in various populations.

“Understanding the social and behavioral complexities associated with stress and unhealthy behaviors by race and ethnicity may help guide interventions to prevent the progression of cognitive impairment,” the study authors wrote in the paper.

Investigators assessed a cohort of 24,448 participants (black and white) aged 45 and over who took part in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. They assessed the association between the prevalence of perceived stress and IBI, in which perceived stress was measured using a 4-item version of the Cohen Perceived Stress Scale. Information was also collected on the impact of race, sex and age on this association.

Of the participants, 22.9% reported high levels of stress, which is associated with worsening cognitive function. Sociodemographic variables, CVD risk factors, lifestyle factors and depressive symptoms do not appear to modulate the strength of this association.

Despite these findings, CVD risk factors were more common among participants who reported higher levels of perceived stress. Additionally, this study supports previous research that has observed an association between poor lifestyle factors and high levels of stress.

The first limitation of this study is that the investigators used an abbreviated version of a questionnaire to measure stress and depressive symptoms. The participation rate was also less than half and limited the generalizability of the results, more than a third of cognitive data was missing at follow-up, and perceived stress was assessed in patients without severe cognitive impairment or dementia.

“The results of our study could have important clinical applications, such as regular screening for stress in high-risk older adults when they present with cognitive decline in primary care,” the study authors wrote.

Reference

[ PubMed ][ Cross Ref ]Kulshreshtha A, Alonso A, McClure L, et al. Association of stress with cognitive function in older black and white American adults. JAMA Netw Open. 2023;6(3):e231860. doi:10.1001/jamanetworkopen.2023.1860