Prolonged Stress Linked to Cognitive Decline in Older Men, But Not Older Women

Older men may be more vulnerable to the negative effects of stress on cognition compared with older women, a study in the American Journal of Geriatric Psychiatry has found. The higher risk in older men may be because they experience greater increases in the inflammatory biomarker interleukin-6 (IL-6) in response to prolonged stress compared with older women.

“Overall, the observed sex-dependent relationships among stress, inflammation, and cognitive functioning highlight the need to consider individual differences when examining modifiable risk factors for cognitive decline,” wrote Emily W. Paolillo, Ph.D., of the University of California, San Francisco (UCSF) Medical Center and colleagues.

The researchers analyzed data from 274 community-dwelling adults aged 52 to 91 years, 88% non-Hispanic White, who participated in the UCSF Memory and Aging Center’s Longitudinal Brain Aging Study. The participants had no history of neurological conditions, major medical conditions, psychiatric or substance use disorders, or cognitive decline. The mean follow-up period was seven years, during which all participants had at least two study visits between 2001 to 2020. At each visit, participants completed tests of three cognitive domains: executive functioning, memory, and processing speed. They also completed the Perceived Stress Scale (PSS), a 10-item scale that measures the degree to which people perceive recent life events or situations as stressful. A subset of 147 participants had blood drawn during at least two study visits to measure IL-6 and tumor necrosis factor alpha (TNF-α), two inflammatory markers known to be involved in the human response to stress.

Data from follow-up analyses showed that higher PSS scores were associated with steeper declines in executive functioning over time in men compared with women, but were not a significant predictor of memory or processing speed in either sex. Among the 147 participants who had blood tests, higher PSS scores were linked to greater increases in IL-6 over time in men, but not women. There appeared to be no significant interaction between PSS scores, sex, and time on TNF-α.

“[T]he observed relationship between higher perceived stress and increases in IL-6 among men suggest that the sex-dependent relationship between perceived stress and cognitive decline may be related to increases in peripheral inflammation,” Paolillo and colleagues wrote. They added that sex hormones may also play a role in the differences between men and women with respect to stress, inflammation, and cognition, but that more research is needed.

“Additional work is also needed to examine whether interventions to monitor and reduce stress in older adults, particularly among men, influence trajectories of systemic inflammation and cognitive performance,” the researchers wrote.

For further information, see the Psychiatric News article “Late-Life Anxiety Linked to Cognitive Decline.”

(Image: iStock/DjelicS)

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Caregivers of Individuals With Schizophrenia Experience High Levels of Distress, Study Finds

Psychological distress among family or friends who provide unpaid support to people with schizophrenia or schizoaffective disorder is much higher than the general population, reports a study published today in Psychiatric Services in Advance. 

The study, by Debra Lerner, Ph.D., of Tufts University and colleagues, identified several variables that seem to have the greatest impact on the level of distress seen in caregivers. “Specifically, the amount of time and effort devoted to caregiving … contributed to distress, as did two additional indicators of demand: risk of medication discontinuation and concern about medication effectiveness,” Lerner and colleagues wrote. “These results suggest that tasks related to managing treatment and symptoms are significant stressors.”

The findings were based on the online questionnaire responses of 1,142 participants, 21 years or older, who identified as informal, unpaid caregivers to friends or relatives with schizophrenia, schizoaffective disorder, or both. The survey assessed demands placed on caregivers, their coping resources and support systems, and cognitive appraisals of caregiving. The survey also included the 10-item Perceived Stress Scale (PSS), which is a validated global measure of psychological distress. Average distress among caregivers as measured by the PSS was 18.9 (out of 39); this was 5.5 points higher than the U.S. average of 13.4 and about 3 points higher than the average reported among survivors of Hurricane Sandy in a study conducted last year (15.6). 

Contributing most to greater distress were caregiver health problems, providing frequent caregiving assistance, monitoring medication, having limited social support, and having negative views of caregiving (such as the task being financially burdensome or lacking in emotional rewards). 

Lerner and colleagues suggested the results point to several ways to reduce caregiver distress, including helping caregivers to “feel more emotionally rewarded in this role” and “maximizing the availability of social supports.”

These “results provide new information regarding the complexity of caregiver distress, including the multiple variables involved in determining the caregiver’s mental health outcome. This study also contributes further evidence of the potential value of providing interventions to address caregiver health, caregiving demands, financial burdens and emotional rewards, and access to social supports,” the authors concluded.

To read more about this topic, see the Psychiatric News article “Factors Predicting Poor MH Health Identified in ICU Caregivers.”

(Image: iStock/PeopleImages)