Perceived stress linked to increased cognitive impairment among Black, white older adults

Perceived stress was associated with both prevalent and incident cognitive function impairment in Black and white older adults, underlining the need for stress assessments among high-risk adults in primary care, according to researchers.

“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,” Ambar Kulshreshtha, MD, PhD, an associate professor of family and preventive medicine at Emory University, and colleagues wrote in JAMA Network Open. “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.”

The researchers analyzed data from the Reasons for Geographic and Racial Differences in Stroke study, which investigated stroke prevalence in a national U.S. sample of older non-Hispanic Black and white populations.

The current analysis consisted of 24,448 participants with a median age of 64 years. Black individuals made up 41.6% of participants, while 59.9% were women.

Perceived stress was measured through the four-item Cohen Perceived Stress Scale at baseline and then at one follow-up visit, while cognitive performance was determined through a six-item screening.

Overall, 22.9% of participants reported high levels of perceived stress. Higher levels of perceived stress were linked to increased odds of poor cognition following adjustments for sociodemographic and depression (adjusted OR [aOR] = 1.37; 95% CI, 1.22-1.53).

“Cardiovascular disease risk factors, such as hypertension, diabetes, and dyslipidemia, were also significantly more frequently observed,” Kulshreshtha and colleagues wrote.

The researchers also examined the association between a change in the Perceived Stress Scale score from baseline to follow up — dichotomized into low vs. high stress — and incident cognitive impairment. They found that the association was statistically significant in both the unadjusted model (OR = 1.62; 95% CI, 1.46-1.8) and after the model was adjusted for sociodemographic factors, CVD risk factors, lifestyle factors and depression (aOR = 1.39; 95% CI, 1.22-1.58).

Additionally, after the model was stratified for sex and race, the association between greater perceived stress and increased cognitive impairment was similar for all demographics, with 1.05 higher odds for Black men and white men and 1.04 higher odds for Black women and white women.

“Potential explanations of how perceived stress is associated with several unfavorable health outcomes include dysfunctional regulation of glucocorticoid secretion, alteration in autonomic tone, and an increased risk of unhealthy lifestyle behaviors,” the researchers wrote. “Multiple studies have also established the biological pathway, and there is evidence that elevated levels of stress biomarkers are associated with brain atrophy and possible cognitive decline.”

They also suggested that experiencing a stressful event may impact “the immediate level of cognition,” with previous literature demonstrating those with more stressful occupations having greater risks for declined cognition later in life.

“More research is needed to explore the underlying mechanisms for this observed association and to develop screening programs and targeted interventions to reduce stress among older adults at risk of cognitive impairment,” they wrote.