Associations of chronic stress and social support with cognition: The role of gender and race/ethnicity in the HABS-HD study cohort

Background Few studies have examined whether chronic stress and social support are potential modifiable risk factors for Alzheimer's disease and related dementias. Objective To examine the associations of chronic stress and social support with domain-specific cognitive z-scores (attention, memory, executive functioning, and language) and assess whether gender or race/ethnicity modify these associations. Methods Participants included 3005 older adults (age range: 50–92) enrolled in the Health and Aging Brain Study-Health Disparities. Social support was measured using the Interpersonal Support and Evaluations List, and chronic stress measured with the Chronic Burden Scale. Linear regression models evaluated associations of chronic stress and/or social support with domain-specific cognitive z-scores, adjusting for age, education, gender, race/ethnicity, and symptoms of anxiety. Interactions between chronic stress or social support and gender or race/ethnicity in relation to cognition were assessed. Additional analyses examined the interrelationship between chronic stress and social support in relation to cognition. Results Higher chronic stress was associated with lower cognitive z-scores; results differed by race/ethnicity. Higher social support was associated with higher cognitive z-scores; results differed by gender and race/ethnicity. In models incorporating both chronic stress and social support, associations between social support and cognition remained, however associations between chronic stress and cognition were attenuated. A combination of high chronic stress/low social support, compared to low chronic stress/high social support, was associated with lower cognitive z-scores. Conclusions High chronic stress and low social support is associated with worse cognition. Future studies are needed to understand the underlying mechanisms, with consideration of gender and race/ethnicity.