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

 

With your massive stress from your incompetent? doctor not having 100% recovery protocols, have your competent? doctor CREATE EXACT PROTOCOLS FOR THIS! You don't want to do it wrong so ask your 'professional' to do it correctly. Oh, your doctor can't do that? Incompetence runs rampant in the stroke medical world, so you'll have to scour the world!

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

Ambar Kulshreshtha,MD, PhD Alvaro Alonso,MD, PhD Leslie A. McClure, PhD Author Affiliations Article Information Cite Metrics JAMA Netw Open

March 7, 2023 2023;6;(3):e231860. doi:10.1001/jamanetworkopen.2023.1860

Question 

Is there an association between perceived stress and cognitive performance?

Findings 

This cohort study of 24 448 Black and White participants aged 45 years or older found an independent association between perceived stress and both prevalent and incident cognitive impairment. 

Meaning 

This study suggests that there may be a need for screening for stress among high-risk older adults when they present in primary care.Perceived stress can have long-term physiological and psychological consequences and has shown to be a modifiable risk factor for Alzheimer disease and related dementias.

Objective 

To 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 Participants

The 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. Perceived 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. Cognitive 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. The 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. This 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.

Introduction

Studies have projected that a 10% to 25% reduction in modifiable risk factors, including behavioral factors, could prevent 1.3 million cases of Alzheimer disease globally.^1,2 Perceived stress is defined as a consequence of events or demands that exceed an individual’s professed ability to cope.^3-5 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 disease.^6,7 Perceived stress among adults is associated with hormonal and inflammatory indicators of accelerated aging as well as excess risk of cardiovascular and stroke morbidity and mortality.^8-11 It has also been associated with sleep problems and poor immunologic function.¹² Studies have shown that the high prevalence of dementia in racial and ethnic minority groups, such as Black populations, may be partly attributable to high levels of stress associated with low socioeconomic status and discrimination throughout the life course.¹³ 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.^14,15 Despite the racial and ethnic disparities in dementia, few longitudinal studies with a diverse population have investigated the association between stress and cognitive impairment, to our knowledge.¹⁶ More studies are needed to rigorously test the association of chronic stress with cognitive decline at different points in the life cycle and in racially and ethnically diverse groups. Understanding the social and behavioral complexities associated with stress and unhealthy behaviors by race and ethnicity can help point toward interventions to prevent the progression of cognitive impairment.

We examined the association between perceived stress and prevalent and incident cognitive impairment (ICI) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a large cohort study comprising Black and White participants. We also explored whether race, sex, and age modify the association between perceived stress and cognition. We hypothesized that higher levels of perceived stress would be associated with a higher risk of cognitive impairment and that this association would not be modified by race, sex, and age.