title: Interaction of stress, lead burden, and age on cognition in older men: the VA Normative Aging Study.
abstract: BACKGROUND
  Low-level exposure to lead and to chronic stress may independently influence cognition. However, the modifying potential of psychosocial stress on the neurotoxicity of lead and their combined relationship to aging-associated decline have not been fully examined.
  
  
  OBJECTIVE
  We examined the cross-sectional interaction between stress and lead exposure on Mini-Mental State Examination (MMSE) scores among 811 participants in the Normative Aging Study, a cohort of older U.S. men.
  
  
  METHODS
  We used two self-reported measures of stress appraisal--a self-report of stress related to their most severe problem and the Perceived Stress Scale (PSS). Indices of lead exposure were blood lead and bone (tibia and patella) lead.
  
  
  RESULTS
  Participants with higher self-reported stress had lower MMSE scores, which were adjusted for age, education, computer experience, English as a first language, smoking, and alcohol intake. In multivariable-adjusted tests for interaction, those with higher PSS scores had a 0.57-point lower (95% confidence interval, -0.90 to 0.24) MMSE score for a 2-fold increase in blood lead than did those with lower PSS scores. In addition, the combination of high PSS scores and high blood lead categories on one or both was associated with a 0.05-0.08 reduction on the MMSE for each year of age compared with those with low PSS score and blood lead level (p < 0.05).
  
  
  CONCLUSIONS
  Psychological stress had an independent inverse association with cognition and also modified the relationship between lead exposure and cognitive performance among older men. Furthermore, high stress and lead together modified the association between age and cognition.
authors.affiliation: Department of Environment Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA. jpeters@hsph.harvard.edu
authors.forename: Junenette L
authors.initials: JL
authors.lastname: Peters
authors.forename: Marc G
authors.initials: MG
authors.lastname: Weisskopf
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
authors.forename: David
authors.initials: D
authors.lastname: Sparrow
authors.forename: Huiling
authors.initials: H
authors.lastname: Nie
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
authors.forename: Robert O
authors.initials: RO
authors.lastname: Wright
authors.forename: Rosalind J
authors.initials: RJ
authors.lastname: Wright
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood / Q000378:metabolism / Q000633:toxicity*; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000503:physiopathology*
chemical_list: D007854:Lead