Psychological stress, cognitive decline and the development of dementia in amnestic mild cognitive impairment

Abstract

to determine the relationship between psychological stress with cognitive outcomes in a multi-centre longitudinal study of people with amnestic mild cognitive impairment (aMci) we assessed three parameters of psychological stress (Recent Life changes Questionnaire (RLcQ); the perceived Stress Scale (PSS) and salivary cortisol) and their relationship with rates of cognitive decline over an 18 month follow up period and conversion to dementia over a 5.5 year period. In 133 aMCI and 68 cognitively intact participants the pSS score was higher in the aMci compared with control group but neither the RLCQ scores nor salivary cortisol measures were different between groups. In the aMCI group the RLCQ and the PSS showed no significant association with cognitive function at baseline, cognitive decline or with conversion rates to dementia but high salivary cortisol levels were associated with RLcQ scores and poorer cognitive function at baseline and lower rates of cognitive decline. No relationship was found between salivary cortisol levels and conversion rate to dementia. We conclude that psychological stress as measured by the RLcQ or pSS was not associated with adverse cognitive outcomes in an aMci population and hypothesise that this may reflect diminished cortisol production to psychological stress as the disease progresses. Longitudinal cohort studies have identified a number of risk factors for the progression of amnestic mild cognitive impairment (aMCI) towards the development of dementia. Age, gender 1 and possession of the Apolipiprotein E (ApoE) ε4 allele 2 are established demographic and genetic risk factors but psychosocial factors are also cited including low educational achievement 3 and depressive illness 4. High levels of psychological stress and other mental health problems are known to be higher in people with aMCI 5-7. Psychological stress is an emerging risk factor for the development of aMCI towards dementia. Several longitudinal cohort studies have demonstrated a link between the experience of psychological stress and cognitive decline later in life 8-13. Psychological stress as a risk factor for the development of aMCI or dementia is more contentious with some studies showing a positive relationship 14-17 and others finding no relationship 18-20. Measures of stress differ from study to study with some studies utilising objective stress measures (e.g. adverse life events); some studies subjective stress measures (e.g. perceived stress or distress measures) and others biological measures (e.g. salivary cortisol) but no single study has examined all three measures. Psychosocial stress, measured by adverse life events, is emerging as a possible risk factor for the development of cognitive impairment in older persons 12,13,21,22. Other studies have suggested that the symptoms of chronic stress (distress) increase the risk of developing aMCI 5,16,23. The biological underpinning of chronic stress has focussed on cortisol production and its potential for hippocampal damage 24,25. Cross sectional studies of t...

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