Association of Stress with Cognitive Function among Older Black and White US Adults

• Type of Material: Article
• Authors: Ambar Kulshreshtha, Emory University; Alvaro Alonso, Emory University; Leslie LA McClure, Drexel University; Ihab Hajjar, Emory University; Jennifer J Manly, Columbia University Irving Medical Center; Suzanne Judd, The University of Alabama at Birmingham
• Language: English
• Date: 2023-03-07
• Publisher: JAMA Network Open.
• Publication Version: Final Published Version
• Copyright Statement: 2023 Kulshreshtha A et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2023.1860
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 6
• Issue: 3
• Start Page: e231860
• End Page: e231860
• Grant/Funding Information: This work was supported by cooperative agreement U01-NS041588 from the National Institute of Neurological Disorders and Stroke (NINDS). Dr Alonso was supported by grants K24HL148521 and P30AG066511 from the National Institutes of Health.; Dr Kulshreshtha was supported by grant K23 AG066931-01A1 from the National Institute on Aging.; Dr Manly was supported by grant 5U01NS041588-20 from the NINDS.
• Keywords: United States; Aged, 80 and over; Middle Aged; Stress, Psychological; Female; Cohort Studies; Humans; Aged; Male; Cognitive Dysfunction; Black or African American; White; Cognition
• Research Categories: Biology, Biostatistics; Health Sciences, Epidemiology

Abstract

IMPORTANCE 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, selfadministered questionnaires, and an in-home examination. Statistical analysis was performed from May 2021 to March 2022. EXPOSURES Perceived stresswas 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. MAIN OUTCOMES AND MEASURES 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. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.