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Influence of Perceived Stress on Incident Amnestic Mild Cognitive Impairment: Results From the Einstein Aging Study

Katz, Mindy J. MPH; Derby, Carol A. PhD; Wang, Cuiling PhD; Sliwinski, Martin J. PhD; Ezzati, Ali MD; Zimmerman, Molly E. PhD; Zwerling, Jessica L. MD, MS; Lipton, Richard B. MD

Alzheimer Disease & Associated Disorders: April-June 2016 - Volume 30 - Issue 2 - p 93–98
doi: 10.1097/WAD.0000000000000125
Original Articles

Stress is a potentially remediable risk factor for amnestic mild cognitive impairment (aMCI). Our objective is to determine whether perceived stress predicts incident aMCI and to determine if the influence of stress on aMCI is independent of known aMCI risk factors, particularly demographic variables, depression, and apolipoprotein genotype. The Einstein Aging Study is a longitudinal community-based study of older adults. The Perceived Stress Scale (PSS) was administered annually in the Einstein Aging Study to participants (N=507; 71 developed incident aMCI; mean follow-up time=3.6 y, SD=2.0) who were aged 70 years and older, free of aMCI and dementia at baseline PSS administration, and had at least 1 subsequent annual follow-up. Cox hazard models were used to examine time to aMCI onset adjusting for covariates. High levels of perceived stress are associated with a 30% greater risk of incident aMCI (per 5-point increase in PSS: hazard ratio=1.30; 95% confidence interval, 1.08-1.58) independent of covariates. The consistency of results after covariate adjustment and the lack of evidence for reverse causation in longitudinal analyses suggest that these findings are robust. Understanding of the effect of perceived stress on cognition may lead to intervention strategies that prevent the onset of aMCI and Alzheimer dementia.

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Departments of *Neurology

Epidemiology and Population Health, Albert Einstein College of Medicine

§Department of Neurology, Montefiore Medical Center, Bronx, NY

Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA

Supported in part by National Institutes of Health Grants NIA 2 P01 AG03949, NIA 1R01AG039409-01, NIA R03 AG045474, CTSA 1UL1TR001073 from the National Center for Advancing Translational Sciences (NCATS), the Leonard and Sylvia Marx Foundation, and the Czap Foundation.

The authors declare no conflicts of interest.

Reprints: Mindy J. Katz, MPH, Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461 (e-mail:

Received March 4, 2015

Accepted October 21, 2015

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