Does Perceived Stress Affect Cognitive Function Among Older Adults?

Perceived stress is associated with prevalent and incident cognitive impairment among Black and White older adults.

Elevated perceived stress levels increase the likelihood of cognitive decline among older adults in the United States, regardless of ethnicity, age, or biological sex, according to study findings published in JAMA Network Open.

Researchers in the US obtained data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based study conducted between 2003 and 2007 that assessed stroke incidence and cognitive decline among an ethnically diverse cohort of US adults aged 45 and older. They analyzed the collected data between May 2021 and May 2022.

They selected 24,448 adults out of the 30,239 from this original study with specific information on stress, physical activity, cognition, alcohol use, smoking status, diabetes, hypertension, body mass index, and anxiety and depression symptoms. Approximately 59.9% of these participants were women; 41.6% were Black and 58.4% were White; and they had a median age of 64.

Perceived stress was measured at baseline and again after 1 year using the Cohen Perceived Stress Scale (PSS). Cognitive function was measured using the Six-Item Screener (SIS) with scores below 5 indicating cognitive impairment.

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.

Of the 24,448 participants, 5589 (22.9%) reported elevated stress levels according to the Cohen PSS. The researchers found that elevated perceived stress levels correlated with a 1.37-fold increased likelihood of poor cognition after accounting for confounding variables such as depression, cardiovascular risk factors, and sociodemographic factors (adjusted odds ratio [aOR], 1.37; 95% CI, 1.22-1.53).

Researchers also examined the link between a change in the PSS from baseline to follow-up (dichotomized as low stress vs elevated stress) and incident cognitive impairment. In both the unadjusted model (OR, 1.62; 95% CI, 1.46-1.8) and the adjusted model for sociodemographic factors, CVD, risk factors, lifestyle factors, and depression (aOR, 1.39; 95% CI, 1.22-1.58), the researchers found the association was statistically significant.

Moreover, following stratification for sex and race in the full model, continuous PSS and greater cognitive impairment was similar for both races and sexes; Black men and White men with 1.05 times higher odds and Black women and White women with 1.04 times higher odds.

“This cohort study suggests that increased levels of perceived stress are associated with both prevalent cognitive impairment and ICI and that the association does not vary by age, race, and sex,” the researchers noted. “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,” they advised.

Study limitations included use of abbreviated assessments for stress and depression symptoms, low participation rate that might restrict generalizability of results, potential unmeasured confounding factors, and the possibility for reverse causality explaining the findings.


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. Published online March 7, 2023. doi:10.1001/jamanetworkopen.2023.1860