title: Perceived stress is associated with subclinical cerebrovascular disease in older adults.
abstract: 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 χ(2)[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results were unchanged 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.
authors.affiliation: Rush Alzheimer's Disease Center and Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; Rush Institute for Healthy Aging, Chicago, IL. Electronic address: neelum_t_aggarwal@rush.edu.
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.forename: Cari J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Todd L
authors.initials: TL
authors.lastname: Beck
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Mendes de Leon
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.forename: Denis A
authors.initials: DA
authors.lastname: Evans
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson Rose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000523:psychology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D059906:Neuroimaging; D057566:Self Report; D013315:Stress, Psychological / Q000150:complications* / Q000473:pathology / Q000523:psychology*
keywords: MR measures; biracial population sample; perceived stress