Neuroendocrine and immunological correlates of chronic stress in 'strictly healthy' populations.

BACKGROUND: Chronic stress has been associated with detrimental or maladaptive neuroendocrine and immunological changes. OBJECTIVES: We assessed the neuroendocrine and immunological correlates of a realistic chronic stress experienced by strictly healthy caregivers of Alzheimer's disease patients and age-matched controls. METHODS: We screened 330 caregivers and 206 non-caregivers according to the 'strictly healthy' conditions established by the SENIEUR protocol. Forty-one strictly healthy caregivers (60.56 +/- 16.56 years) and 33 non-stressed controls (60.27 +/- 14.11 years) were selected for this study. Salivary cortisol and dehydroepiandrosterone sulfate (DHEAS) were assessed at multiple points by radioimmunoassay. Peripheral T cell proliferation and cellular sensitivity to glucocorticoids (corticosterone and dexamethasone, DEX) were evaluated by colorimetric assays. We also examined the hypothalamic-pituitary-adrenal (HPA) axis response to the administration of a low-dose DEX in vivo. RESULTS: The caregivers were significantly more stressed, anxious and depressed than non-caregivers (all p < 0.0001), in contrast to similar cortisol levels. Caregivers had reduced DHEAS levels (-32%, p < 0.0001), an increased cortisol/DHEAS ratio (39.7%, p < 0.0001) and impaired HPA axis response to DEX intake. Caregivers had a higher T cell proliferation (p < 0.0001) and increased sensitivity to glucocorticoids in vitro (p < 0.01) as compared to non-stressed controls. CONCLUSIONS: Our results suggest that the maintenance of health in chronically stressed populations may be associated with both protective and detrimental neuroendocrine and immunological changes.

Risk factors for cerebrovascular disease and cognitive function in the elderly.

OBJECTIVE: To determine whether stroke risk factors and cognitive dysfunction are concomitant in individuals over the age of 60. METHODS: The cognitive abilities of elderly individuals with different degrees of risk as per the Framingham stroke risk profile were compared. The Framingham stroke risk profile was used to calculate the risk of an ischemic cerebral event. Neuropsychological tests included the Buschke Selective Reminding Test, verbal fluency (animals), clock drawing, Rey Auditory Verbal Learning, digit span and vocabulary. A random and typical population sample was used in the study, selected from the 200 elderly residents in the area surrounding the primary health care facility (Morada das Flores Clinic, Porto Alegre). Forty-six elderly individuals were included in the study. RESULTS: The elderly individuals with a risk profile, had lower memory test performance levels (NF, p=0.02) and planning capacity (clock drawing test, p=0.03). Diabetes proved to be related to delayed recall performance in the Rey auditory verbal learning test (p=0.04). CONCLUSION: The presence of stroke risk factors in the elderly was associated with worse cognitive performance for memory and executive functions.

Fatores de risco para doença cerebrovascular e função cognitiva em idosos / Risk factors for cerebrovascular disease and cognitive function in the elderly

OBJETIVO: Identificar a concomitância de fatores de risco para acidente vascular cerebral e de disfunção na cognição de idosos acima de 60 anos. MÉTODOS: Idosos com diferentes graus de risco de acordo com a escala de Framinghan para acidente vascular cerebral (AVC) tiveram comparadas suas habilidades cognitivas. O risco de evento isquêmico cerebral foi calculado pela escala de Framingham para AVC. Os instrumentos neuropsicológicos aplicados foram os testes de memória seletiva de Buschke, fluência verbal (animais), desenho do relógio, teste de aprendizado auditivo verbal de Rey, dígito span e vocabulário. O estudo foi feito com uma amostra randômica e representativa de todos os 200 idosos residentes na área de abrangência de uma unidade de atenção primária de saúde (posto Morada das Flores, Porto Alegre). Foi incluído no estudo um número representativo de 46 idosos. RESULTADOS: Os idosos com escore de risco obtiveram um desempenho inferior em testes de memória (SOL com p=0,02) e na capacidade de planejamento (Teste do relogio com p=0,03). A presença de diabetes manteve-se como fator associado ao desempenho da evocação tardia do teste de aprendizado auditivo verbal de Rey (p=0,04). CONCLUSÃO: A presença de fatores de risco para AVC esteve associada com pior performance cognitiva em funções de memória e em funções executivas em idosos.

OBJECTIVE: To determine whether stroke risk factors and cognitive dysfunction are concomitant in individuals over the age of 60. METHODS: The cognitive abilities of elderly individuals with different degrees of risk as per the Framingham stroke risk profile were compared. The Framingham stroke risk profile was used to calculate the risk of an ischemic cerebral event. Neuropsychological tests included the Buschke Selective Reminding Test, verbal fluency (animals), clock drawing, Rey Auditory Verbal Learning, digit span and vocabulary. A random and typical population sample was used in the study, selected from the 200 elderly residents in the area surrounding the primary health care facility (Morada das Flores Clinic, Porto Alegre). Forty-six elderly individuals were included in the study. RESULTS: The elderly individuals with a risk profile, had lower memory test performance levels (NF, p=0.02) and planning capacity (clock drawing test, p=0.03). Diabetes proved to be related to delayed recall performance in the Rey auditory verbal learning test (p=0.04). CONCLUSION: The presence of stroke risk factors in the elderly was associated with worse cognitive performance for memory and executive functions.