title: The Effects of Stress on Cognitive Aging, Physiology and Emotion (ESCAPE) Project.
abstract: BACKGROUND
  Despite evidence that psychological stress is an important risk factor for age-related cognitive loss, little research has directly evaluated psychological and physiological mediators of the relationship between stressful experiences and cognitive function. A key objective of the ESCAPE (Effects of Stress on Cognitive Aging, Physiology, and Emotion) project is to evaluate whether engaging in stress-related unconstructive repetitive thought (URT) is a pathway through which stressful experiences negatively affect cognitive health over the short- and long-term. Over the short-term, we hypothesize that engaging in URT will deplete attentional resources and result in worse cognitive performance in daily life. Over the long-term, we expect that the effects of chronic stress, from repeated exposure to stressors and regular engagement in URT, will be apparent in dysregulated hypothalamic-pituitary-adrenal (HPA) axis function and inflammation. Over time, stress-related physiological dysregulation will result in accelerated cognitive decline.
  
  
  METHODS
  This study utilizes a prospective longitudinal measurement-burst design. A systematic probability sample of participants aged 25 to 65 is recruited from residents of the Bronx, NY. Consenting participants complete a baseline assessment and follow-up waves at 9, 18, and 27 months post-baseline. At each wave, participants complete a 14 day measurement burst of brief surveys and cognitive assessments delivered via study smartphones during daily life. Participants provide saliva samples four times each day for five days during the measurement burst and fasting blood samples at the end of each burst from which cortisol and dehydroepiandrosterone sulfate (DHEAS), circulating inflammatory markers, and stimulated inflammatory responses to lipopolysaccharide in whole blood are determined.
  
  
  CONCLUSIONS
  This study takes a multi-pronged approach to assessing stress (i.e., early adversity, chronic strains, major events, daily hassles), psychological mediators (e.g., URT), biological mechanisms (i.e., HPA function, inflammation) and outcomes across different time-scales (i.e., momentary cognitive performance, cognitive decline across years). The systematic probability sample is locally representative and can be compared with national norms on key markers of health and well-being. The findings will improve our understanding of how environmental, psychological, and physiological stress-related influences accumulate to affect cognitive health and identify potential targets (e.g., URT, inflammation) for prevention and intervention promoting cognitive health.
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, USA. staceyscott@usf.edu.
authors.forename: Stacey B
authors.initials: SB
authors.lastname: Scott
authors.affiliation: Department of Biobehavioral Health, Pennsylvania State University, Pennsylvania, USA. jeg32@psu.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Graham-Engeland
authors.affiliation: Department of Biobehavioral Health and College of Nursing, Pennsylvania State University, Pennsylvania, USA. cge2@psu.edu.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Engeland
authors.affiliation: Departments of Biobehavioral Health and Medicine, Pennsylvania State University and Hershey Medical Center, Pennsylvania, USA. jms1187@psu.edu.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Smyth
authors.affiliation: Department of Human Development and Family Studies and Center for Healthy Aging, Pennsylvania State University, Pennsylvania, USA. dma18@psu.edu.
authors.forename: David M
authors.initials: DM
authors.lastname: Almeida
authors.affiliation: Department of Neurology, Albert Einstein College of Medicine, Bronx, USA. mindy.katz@einstein.yu.edu.
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Katz
authors.affiliation: Department of Neurology, Department of Psychiatry and Behavioral Sciences, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, USA. richard.lipton@einstein.yu.edu.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Lipton
authors.affiliation: Center for Healthy Aging and College of Nursing, Pennsylvania State University, University Park, Pennsylvania, PA, 16802, USA. jam935@psu.edu.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Mogle
authors.affiliation: Department of Human Development and Family Studies and Center for Healthy Aging, Pennsylvania State University, Pennsylvania, USA. edm172@psu.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Munoz
authors.affiliation: Department of Human Development and Family Studies, Pennsylvania State University, Pennsylvania, USA. nur5@psu.edu.
authors.forename: Nilam
authors.initials: N
authors.lastname: Ram
authors.affiliation: Center for Healthy Aging and College of Nursing, Pennsylvania State University, University Park, Pennsylvania, PA, 16802, USA. mjs56@psu.edu.|Department of Human Development and Family Studies and Center for Healthy Aging, Pennsylvania State University, Pennsylvania, USA. mjs56@psu.edu.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Sliwinski
mesh_terms: D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D000066492:Cognitive Aging / Q000502:physiology / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D008297:Male; D017063:Outcome Assessment, Health Care; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011446:Prospective Studies; D012107:Research Design; D013315:Stress, Psychological / Q000150:complications / Q000378:metabolism / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone