Stress, Anxiety, and Exhaustion May Be Related With Dementia, Alzheimer Disease Risk

A study published in JAMA Network Open found that psychologic distress may be a predictor for increased all-cause dementia risk.

Investigators from the Finnish Institute for Health and Welfare sourced data for this study from the Finnish health and risk factor study (National FINRISK Study) which has collected data every 5 years since 1972. In this analysis, individuals (N=67,688) who participated in the survey between 1972 and 2007 were evaluated for stress, depressive mood, nervousness, and exhaustion and these symptoms were related with dementia risk.

The study population comprised individuals with a mean age of 45.2 (SD, 12.2) years at baseline, 51.7% were women, 36.8% had obtained a high level of education, and 8.5% had a low activity level. In the survey, 15.2% indicated they were more stressed than others, 13.1% were often exhausted, 8.1% were often nervous, and 5.6% often had a depressed mood.

A total of 7935 of the participants were diagnosed with dementia at an average age of 79.0 (SD, 7.4) years.

Risk for dementia was associated with increased stress (adjusted hazard ratio [aHR], 1.24), often having depressed mood (aHR, 1.22), often being nervous (aHR, 1.21), and often being exhausted (aHR, 1.17) compared with individuals who reported never having or a similar level of the symptoms as the entire population.

Stratified by age at baseline, dementia rates were highest for individuals reporting frequent depressive mood (incidence rate ratio [IRR], 2.31), frequent exhaustion (IRR, 1.74), more stress than others (IRR, 1.49), and frequent nervousness (IRR, 1.47) at 65 years and older; frequent depressive mood (IRR, 1.32) and frequent nervousness (IRR, 1.24) at 45 years and younger; and more stress than others at 45 to 65 years of age (IRR, 1.21) compared with those of similar ages who reported never experiencing or having similar levels of the symptoms as others.

Among the dementia cohort, 73.9% were diagnosed with Alzheimer disease (AD). Rates of AD were higher among individuals reporting more stress than others (adjusted IRR [aIRR], 1.24) and those who were often nervous (aIRR, 1.13) or exhausted (aIRR, 1.11).

Study authors noted that risk for mortality without dementia (n=19,647) was also associated with increased stress (aHR, 1.15), often having depressed mood (aHR, 1.32), often being nervous (aHR, 1.16), often being exhausted (aHR, 1.18) compared with individuals who reported never having or a similar level of the symptoms as the entire population.

This study was limited by the fact that no data were available about established dementia risk factors of traumatic brain injury, hearing impairment, and low social interaction.

Study authors concluded, “The findings of this large Finnish cohort study with register-based follow-up of up to 45 years suggest that competing risk of death, reverse causation, and ascertainment bias are likely to affect estimation of the association of mental health with dementia risk. After considering these phenomena, we suggest that symptoms of psychological distress are etiological risk factors for dementia but only weakly increase the incidence of dementia in the presence of competing risk of death.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.