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Daily Dose: Stress & Cognitive Function among Older Adults


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 14, 2023, we reported on a study published in JAMA Network Open that examined the association between perceived stress and cognitive impairment in a large cohort study of Black and White participants aged ≥45 years.

The study

In addition to evaluating the association between perceived stress and cognitive impairment, the researchers also examined wither race, sex, and age would modify the association. A total of 30 239 participants were enrolled during recruitment between 2003 and 2007, with ongoing follow-up conducted annually. The final cohort for analysis numbered 24 448. Participants had a median age of 64 years, 60% were women, and 41.6% were non-Hispanic Black.

Overall, 22.9% of participants reported elevated levels of stress. In models adjusted for sociodemographic variables, cardiovascular (CV) risk, and depression, higher levels of perceived stress were associated with 1.37 times greater odds of poor cognition (95% CI, 1.22-1.53). Factors associated with increased perceived stress included younger age, female sex, and being Black. CV risk factors were “significantly more frequently observed” in this group.

When the investigators 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 it 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, CV risk factors, lifestyle factors, and depression (aOR, 1.39; 95% CI, 1.22-1.58). They found no interaction with age, race, and sex.

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.

Note from authors

"Our results from this large cohort of Black and White individuals suggest that there is an independent association between perceived stress and cognition. The magnitude of the association did not meaningfully change after adjustment for sociodemographic variables, CVD risk factors, lifestyle factors, and depressive symptoms. In addition, using the longitudinal follow-up data in the REGARDS study, our results show that a change in perceived stress is also independently associated with ICI. The results were consistent whether perceived stress was continuous or categorical and across age, race, and sex."

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