Perceived stress is associated with subclinical cerebrovascular disease in older adults

Neelum T. Aggarwal, Cari J. Clark, Todd L. Beck, Carlos F.Mendes De Leon, Charles DeCarli, Denis A. Evans, Susan A.Everson Rose

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective: To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort. Methods: Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction. Results: Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient = -0.111, SE = 0.049, t[563] = -2.28, p = 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald ×2[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results wereunchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia. Conclusions: Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort.

Original languageEnglish (US)
Pages (from-to)53-62
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Issue number1
StatePublished - Jan 2014

Bibliographical note

Funding Information:
The authors are indebted to the hundreds of participants in the CHAP study. The authors also thank the study coordinators, Jennifer Tarpey and Colleen Plunkett, data and analytic programmers, George Dombrowski, M.S., and the faculty and staff of the Rush Institute for Healthy Aging. This study was supported by the National Institutes of Health (NIH) grants HL084209 , AG11101 , and ES010902 . Dr. Clark was supported by grant 1UL1RR033183 from the National Center for Research Resources (NCRR) of the NIH to the University of Minnesota Clinical and Translational Science Institute (CTSI). The University of Minnesota CTSI is part of a national Clinical and Translational Science Award consortium created to accelerate laboratory discoveries into treatments for patients. Contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the CTSI or the NIH.

Funding Information:
Dr. Clark received research support from NIH grants R01 HL084209 and 1UL1RR033183 . Mr. Beck received research support from NIH grants R01 AG11101 and R01 HL084209 . Dr. Aggarwal has received honoraria for serving as a consultant for Pfizer from 2009–2010, and is funded by grants from NIH: R01 AG022018 , P30 AG010161 [Clinical Core Co -Leader] , R01 AG011101 , R01 AG009966 , R01 HL084209 , R01 AG032247 ; U01 AG010483 [Site Principal Investigator] and the Alzheimer's Association: IIRG-06–27429. Dr. DeCarli serves as a Editor in Chief for Alzheimer's Disease and Associated Dementias--An International Journal and is a Consultant to Advanir, Takeda, and Bayer Corporations. Dr. Everson-Rose was Principal Investigator and received research support from NIH grant R01 HL084209 and is an Associate Editor and on the Editorial Board of Psychosomatic Medicine. Dr. Mendes de Leon served as Associate Editor of the Journals of Gerontology Social Sciences and serves on the editorial boards of Psychosomatic Medicine, the Journal of Aging & Health, the International Journal of Behavioral Medicine, and the Archives of Internal Medicine and receives/has received research support from the NIH [Principal Investigator or Co –Investigator] grants R01 AG021972 , R01 HL084209 , R01 AG11101 , R01 ES010902 , R01 AG032247 and R01 AG022018 . Dr. Evans received honoraria for serving on the Data Monitoring Committee of a trial for Eli Lily and Company from 2007 to 2008. He is funded [Principal Investigator or Co-Investigator] by NIH grants AG11101 , AG036650 , AG09966 , AG030146 , AG10161 , AG021972 , ES10902 , NR009543 , HL084209 , and AG12505l .


  • Biracial population sample
  • MR measures
  • Perceived stress


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