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Date of release: 22 November, 2010

Psychological stress associated with dementia in middle-aged women


The study by Lena Johansson and colleagues recently published in Brain [1] was based on data from a population cohort, as a part of the Prospective Population Study of Women in Gothenburg, Sweden. The objective was to analyze the relationship between psychological stress and the development of dementia in late life. The study followed 1415 women, aged 38–60 years, during a period of 35 years. The women were examined between 1968 and 2000 at three times, in which a standardized single question about psychological stress was asked. The diagnosis of dementia was performed according to the Diagnostic and Statistical Manual of Mental Disorders (1987). 


 


During the 35-year study span, 161 participants developed dementia: 105 with Alzheimer’s disease (32 with cerebrovascular disease, 73 without cerebrovascular disease), 40 with vascular dementia and 16 with other types of dementias. The authors found that the women who experience frequent episodes of stress and anxiety in middle age were twice as more likely to develop dementia, especially Alzheimer’s disease. Compared to females reporting no stress, hazard ratios (95% confidence interval) for incident dementia were 1.10 (0.71–1.71), 1.73 (1.01–2.95), and 2.51 (1.33–4.77) in women reporting stress at one, two, or three examinations, respectively. The low number of cases of pure vascular dementia, as the authors mentioned, is probably linked to early mortality due to cardiovascular disease, thus underestimating the relationship between stress and vascular dementia. The mean time of dementia onset was 25 years from baseline examination.

Comment

This is the first study to show that psychological stress in middle age can lead to dementia in later life. Previous studies have shown that chronic distress can induce damage, affecting parts of the brain, thus leading to hippocampal atrophy and deposition of β-amyloid peptide and tau protein in the brain. Stress is also associated with persisting levels of cortisol that not only contribute to hippocampal atrophy but also play an important role in the onset of coronary heart disease, infection and accelerated aging [2].
 
The dramatic effects of war have been observed in a recent study [3] where those veterans from Iraq and Afghanistan who suffer from post-traumatic stress disorder have been found to have a greater risk for dementia. Over 7 years of follow-up, from 2000 to 2007, 31.1 (17.2%) of the veterans developed dementia. 
 
But, as far as we know, the same environmental stressors are not likely to induce similar stress reactions in all people due to their different personality traits. Vulnerability and capacity for resilience to major stress are determinants in an individual’s life.

Comentario

Debora Yankelevich
Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina

    References

  1. Johansson L, Guo X, Waern M, et al. Midlife psychological stress and risk of dementia: a 35-year longitudinal population study. Brain 2010;133:2217-24.
    http://www.ncbi.nlm.nih.gov/pubmed/20488887

  2. Sapolsky R. Atrophy of the hippocampus in posttraumatic stress disorder: how and when? Hippocampus 2001;11:90-1.
    http://www.ncbi.nlm.nih.gov/pubmed/11345129

  3. Yaffe K, Vittinghoff E, Lindquist K, et al. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry 2010;67:608-13.
    http://www.ncbi.nlm.nih.gov/pubmed/20530010