The risk of dementia is higher in people with earlier signs of psychological distress
The risk of dementia was higher in people who had signs of psychological distress earlier in life, found a Finnish cohort study.
In more than 67,000 people with an average age of 45, self-reported anxiety symptoms — especially stress and fatigue — were associated with a 17 to 24 percent increased risk of dementia over a 25-year follow-up period. reported by Doctor of Medicine Sonja Sulkava from the Institute of Health and Well-being in Helsinki and the authors.
These self-reported symptoms were associated with an 8 to 12 percent increase in lifetime dementia, adjusting for the competing risk of death, which was more common than dementia over time, Sulkava and colleagues wrote JAMA network open.
“Our study suggests that symptoms of psychological distress, such as exhaustion, depressed mood, and the experience of stress, are risk factors for dementia, not just precursors of an underlying dementia disorder,” Sulkava wrote in an email. MedPage today.
“Previous studies have shown a connection between symptoms of psychological distress and dementia, but the nature of the connection is still unclear,” writes Sulkava. “We clarified this association using a large population data set with 10 to 45 years of follow-up and careful modeling of death from other causes.”
The study used data from 67,688 people who completed national FINRISK survey surveys between 1972 and 2007. Participants self-reported symptoms of psychological distress in the previous month, including whether they experienced more stress than other people and whether they experienced depression, exhaustion, and nervousness often, sometimes, or never. The cohort was linked to the Finnish health register for dementia and mortality data.
About half (51.7%) of the participants were women. The basic age varied between 25 and 74 years, and the average age was 45.4 years. Results were adjusted for age, gender, baseline year, follow-up time, education level, BMI, smoking, diabetes, systolic blood pressure, cholesterol, and physical activity.
During an average follow-up of 25.4 years, 7,935 participants were diagnosed with dementia. Competing risk of death was more common, occurring in 19,647 people.
In a Poisson cause-specific model, fatigue was associated with subsequent all-cause dementia (odds ratio [IRR] 1.17, 95% CI 1.08-1.26), as well as stress (IRR 1.24, 95% CI 1.11-1.38). These relationships remained significant in sensitivity analyses.
A subdistribution risk model assessing the effect on cumulative incidence also showed an association of fatigue (HR 1.08, 95% CI 1.01-1.17) and stress (HR 1.12, 95% CI 1.00-1.25) with dementia risk over time with. In contrast, depressive status (HR 1.08, 95% CI 0.98-1.20) did not show a statistically significant association.
Research on psychological distress and brain health is “far from clear,” noted Yoram Barak, MD, MHA, a psychiatrist at the University of Otago in Dunedin, New Zealand. accompanying editorial.
This “advanced analysis” adds “an important dimension to the field by considering the competing risk of death,” Barak noted. “This should become the standard when investigating these questions.”
But relying on survey questions about past-month experiences may negate the ability to understand how stress may be a cause of dementia, because information on lifetime traits or clinically diagnosed anxiety or depression was not collected, Barak noted.
“We need to take the field further by creatively exploring lifelong patterns of emotional states and relationships,” he wrote. “Life trajectories of individuals and couples teach us more about stress, anxiety, tension, neuroticism and dementia.”
Although the research questions on psychological distress do not form a validated multi-item questionnaire, single-item measurements of different symptoms of psychological distress are significantly correlated, Sulkava and colleagues stated.
The study had other limitations, they acknowledged. Information on traumatic brain injury, hearing loss and low social contact – three known risk factors for dementia – was not available. In addition, participants with missing covariate data had more risk factors for dementia or mortality.
Announcements
This research has been supported by the Emil Aaltonen Foundation, the Maud Kuistila Memorial Foundation, the Academy of Finland and the Gyllenberg Foundation.
Sulkava reports on grants from the Emil Aaltonen Foundation, the Maud Kuistila Memorial Foundation, and the Gyllenberg Foundation; and a family member employed by Amialife Oy.
Barak did not comment on the disclosure.
Primary source
JAMA network open
Source reference: Sulkava S, et al “Association of psychological distress and incident dementia in a population-based cohort in Finland” JAMA Netw Open 2022; DOI: 10.1001/jamanetworkopen.2022.47115.
Secondary source
JAMA network open
Source reference: Barak Y “Stress, anxiety, tension, neuroticism and risk of dementia” JAMA Netw Open 2022; DOI: 10.1001/jamanetworkopen.2022.47124.