Feasibility of Hair Cortisol as a Biomarker of Chronic Stress in People With Dementia

Abstract

Hair cortisol concentrations (HCC) are an innovative way to measure chronic stress relying on a small sample of hair. To date, there are no studies that have studied HCC as a biomarker of chronic stress in individuals with dementia. Given the vulnerability to chronic stress in people with dementia, using HCC as an objective measure of physiological stress in those with dementia has potential to enhance our understanding of this population. The goal of this exploratory, multidisciplinary, pilot study was to establish feasibility of HCC testing in people with dementia as a biomarker of chronic stress. HCC was examined over a 6-month period to assess physiological stress response during a transition to memory care. Newly admitted memory care residents ( n = 13, mean age = 82) were followed over 6 months. Residents’ hair samples and health information were collected at 3-month intervals. HCC levels significantly changed during the transition to memory care, which may reflect chronic physiological stress. Participants with frequent behavioral and psychological symptoms of dementia (BPSD) had significantly lower HCC at baseline and exhibited a blunted cortisol reactivity at follow-up. Based on detected changes in HCC, participants likely experienced stress reactions during the transition to memory care, providing preliminary evidence that HCC may be a useful, non-invasive measure of physiological stress in this population. This approach may also be applied to understanding the significance of person-centered care environments on minimizing chronic stress for people with dementia.

Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting

“…We will use videos of the home visits and FaceReader software (Noldus) to assess the heart rate variability of the person with dementia and the caregiver as an indicator of acute physiological stress before, during, and shortly after IML (immediate and short-term effects) [ 26 , 44 ]. FaceReader uses photoplethysmography to detect heart rate in video recordings of faces [ 45 ].…”

“…FaceReader uses photoplethysmography to detect heart rate in video recordings of faces [ 45 ]. We will use the cortisol/dehydroepiandrosterone concentrations in the hair samples collected in the first and third home visits as an indicator of chronic physiological stress before and after six weeks of IML (i.e., longer-term effects) [ 26 , 46 ].…”

“…In our study, we examine the short- and longer-term impact of IML on heart rate variability and, for the first time, cortisol levels in hair. Analysing cortisol in the hair of people with dementia is feasible and also has a number of advantages in pragmatic RCTs [ 26 ], and offers a promising methodological approach for investigating the longer-term effects of IML on physiological stress [ 26 ].…”

Dyadic Hair Cortisol Self-Collection Procedure

“…HCC is a reliable, low-participant burden biomarker in older adults (Wright et al, 2015). Recent work supports the feasibility and use of hair cortisol to measure stress in people living with dementia (Kim et al, 2022).…”

“…Cortisol is a glucocorticoid hormone regulated by the hypothalamic–pituitary–adrenal (HPA) axis. Although cortisol is important for many functions, the accumulation of prolonged or irregular patterns of cortisol secretion resulting from chronic stress can be maladaptive and adversely affect health (Kim et al, 2022; McEwen, 2004; Wright et al, 2015). Because of the effect of time of day and stressors on endogenous cortisol levels, methods differ for studying long-term (chronic) stress versus short-term (acute) stress (Russell et al, 2012).…”