Independent Association Between Perceived Stress, Cognitive Impairment for Older Adults


New research assessed the association between perceived stress and cognitive function in Black and White adults, finding that stress screening for high-risk adults may be needed.

Ambar Kulshreshtha, MD, PhD


Ambar Kulshreshtha, MD, PhD


Among older adults, there may be a need for stress screening at the time they present in primary care, given findings suggesting an independent association between prevalent/incident cognitive impairment and perceived stress.

This research was conducted to assess the association between cognitive impairment and perception of stress—measured through the Cohen Perceived Stress Scale—for Black and White patients in the age group of 45 and up.

The study was authored by Ambar Kulshreshtha, MD, PhD, from the Department of Epidemiology at Rollins School of Public Health, Emory University.

“We examined the association between perceived stress and prevalent and incident cognitive impairment (ICI) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a large cohort study comprising Black and White participants,” Kulshreshtha and colleagues wrote. “We also explored whether race, sex, and age modify the association between perceived stress and cognition.”

Background and Findings

The investigators conducted a cohort study of 24,448 Black and White study participants who were aged 45 or older, in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

The researchers recruited participants beginning from 2003 to 2007 with continued follow-up each year. They collected information through in-home examinations, questionnaires for participants that were self-administered, and by telephone call.

The investigators performed their statistical analysis from May 2021 to March 2022, assessing participants’ perceptions of stress using the 4-item version of the Cohen Perceived Stress Scale. It was assessed at the baseline visit and during 1 follow-up visit.

They used the Six-Item Screener (SIS) to assess participants’ cognitive functions, with below 5 ranking being considered as cognitively impaired.

Overall, the investigators found that changes in the Perceived Stress Scale score with incident cognitive impairment were reported to be substantial for both the unadjusted model and the adjustment model (which took into account sociodemographic factors, depression, and cardiovascular risk).

The research team also noted that they found no interaction with race, age, and sex for the study participants’ results.

Additionally, the investigators reported that elevated perceived stress levels were associated with 1.37 times higher odds of having poorer cognition (after adjustment for sociodemographic variables, cardiovascular risk factors, and depression).

“Our results from this large cohort of Black and White individuals suggest that there is an independent association between perceived stress and cognition,” they wrote. “The magnitude of the association did not meaningfully change after adjustment for sociodemographic variables, CVD risk factors, lifestyle factors, and depressive symptoms.”


  1. Kulshreshtha A, Alonso A, McClure LA, Hajjar I, Manly JJ, Judd S. 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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