Increased Levels of Perceived Stress May Be Linked to Poor Cognition


Perceived stress and cognitive performance are independently associated. Stress can also increase the risk of worsening cognition.

Elevated levels of perceived stress were associated with a 1.37 times higher likelihood of poor cognitive function, regardless of race, according to a study published in JAMA Network Open. In the long-term follow up, incident cognitive impairment (ICI)—defined as a shift from intact to impaired cognition from first to last assessment—was also associated with perceived stress.

“Understanding the association between perceived stress and cognitive functioning in different subgroups is important for designing targeted interventions and could have substantial public health implications,” the study authors wrote.

Not only is perceived stress associated with poor cognitive function, but perceived stress may be a precursor of poor cognition, according to the study. Perceived stress can have long-lasting effects on physiological and psychological function.

It is a modifiable risk factor that can lead to cognitive impairment, Alzheimer disease, accelerate aging, reduce cardiovascular health, and is associated with sleep problems and immune dysfunction. Perceived stress may also worsen unhealthy behaviors, such as smoking and physical activity.

“Perceived stress is defined as a consequence of events or demands that exceed an individual’s professed ability to cope,” the study authors wrote. “Perceived stress can have long-term physiological and psychological consequences and has been shown to be a modifiable risk factor for mild cognitive impairment and Alzheimer disease. Perceived stress among adults is associated with hormonal and inflammatory indicators of accelerated aging as well as excess risk of cardiovascular and stroke morbidity and mortality. It has also been associated with sleep problems and poor immunologic function.”

Stress from low socioeconomic status and discrimination could contribute to a higher incidence of dementia in racial and ethnic minority groups; however, there are few long-term studies investigating stress and cognitive impairment in diverse populations.

“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 study authors wrote in the paper.

Investigators evaluated a cohort of 24,448 participants (Black and White) aged 45 years and older who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. They evaluated the association between the prevalence of perceived stress and ICI, in which perceived stress was measured using a 4-item version of the Cohen Perceived Stress Scale. Insights were gathered about the impact of race, sex, and age on this association as well.

Among participants, 22.9% reported elevated levels of stress, which is associated with worse cognitive function. Sociodemographic variables, CVD risk factors, lifestyle factors, and depressive symptoms did not appear to modulate the strength of this association.

Despite these findings, CVD risk factors were more prevalent in participants who reported higher levels of perceived stress. Additionally, this study supports prior research that observed an association between poor lifestyle factors and elevated levels of stress.

The first limitation of this study is that investigators used an abbreviated version of a questionnaire to measure stress and depressive symptoms. The participant rate was also less than half and limited the generalizability of findings, more than one-third of the cognition data were missing at follow-up, and perceived stress was assessed among patients without severe cognitive impairment or dementia.

“Findings from our study could have important clinical applications, such as regular screening for stress among high-risk older adults when they present with cognitive decline in primary care,” the study authors wrote.


Kulshreshtha A, Alonso A, McClure L, et al. Association of Stress With Cognitive Function Among Older Black and White US Adults. JAMA Netw Open. 2023;6(3):e231860. doi:10.1001/jamanetworkopen.2023.1860

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