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Chronic distress and incidence of mild cognitive impairment

From Rush Alzheimer's Disease Center (R.S.W., J.A.S., P.A.B., D.A.B.) and Rush Institute for Healthy Aging (Y.T.) and Departments of Neurological Sciences (R.S.W., J.A.S., D.A.B.), Behavioral Sciences (R.S.W., P.A.B.), Internal Medicine (Y.T.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; and Center for Neurobiology and Behavior (S.E.A.), University of Pennsylvania, Philadelphia.

Address correspondence and reprint requests to Dr. Robert S. Wilson, Rush Alzheimer's Disease Center, Rush University Medical Center, 600 South Paulina, Suite 1038, Chicago, IL 60612 rwilson{at}rush.edu

Objective: Mild cognitive impairment (MCI) is associated with increased morbidity and mortality but its development is not well understood. Here we test the hypothesis that chronic psychological distress is associated with increased incidence of MCI in old age.

Methods: Participants are older persons from two cohort studies with uniform annual clinical evaluations which included detailed cognitive testing and clinical classification of MCI. We excluded persons with dementia or MCI at baseline; follow-up data were available on 1,256 persons without cognitive impairment (95% of those eligible). At baseline, they completed a six-item measure of neuroticism (mean = 15.6, SD = 6.6), an indicator of the tendency to experience psychological distress.

Results: During up to 12 years of follow-up, 482 persons (38%) developed MCI. Risk of MCI increased by about 2% for each one unit increase on the distress scale (relative risk [RR] = 1.02; 95% CI: 1.01, 1.04), with the association slightly stronger in men than women. Overall, a distress-prone person (score = 24, 90th percentile) was about 40% more likely to develop MCI than someone not prone to distress (score = 8, 10th percentile). Adjustment for depressive symptomatology at baseline did not substantially change results (RR = 1.02; 95% CI: 1.00, 1.03). Depressive symptoms were also related to risk of MCI but not after controlling for distress score. In mixed-effects models, higher distress score was associated with lower level of function in multiple cognitive domains at baseline and more rapid cognitive decline, especially in episodic memory.

Conclusion: Among older persons without manifest cognitive impairment, higher level of chronic psychological distress is associated with increased incidence of mild cognitive impairment.

Supported by National Institute on Aging grants R01 AG17917, R01 AG024871, R01 AG15819, K23 AG23040, and P30 AG10161, and the Illinois Department of Public Health.

Disclosure: The authors have reported no conflicts of interest.

Received October 25, 2006. Accepted in final form February 7, 2007.

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