Perceived Stress and Mild Cognitive Impairment among 32,715 Community-Dwelling Older Adults across Six Low- and Middle-Income Countries

Abstract

Perceived stress may be a modifiable risk factor for mild cognitive impairment (MCI) and ultimately dementia, but studies on this topic from low- and middle-income countries (LMICs) are lacking. Objective: We assessed the association between perceived stress and MCI in six LMICs (China, Ghana, India, Mexico, Russia, and South Africa) using nationally representative data. Methods: Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. A perceived stress score (range 0 [lowest stress] to 10 [highest stress]) was computed based on two questions from the Perceived Stress Scale. Multivariable logistic regression analysis was conducted to assess the as-sociation between perceived stress and MCI. Results: The mean (SD) age of the 32,715 participants was 62.1 (15.6) years and 51.7% were females. After adjustment for potential confounders including depression, in the overall sample, a one-unit increase in the perceived stress score was associated with a 1.14 (95% CI = 1.11-1.18) times higher odds for MCI. The association was similar among those aged 50-64 and ≥65 years. Countrywise analysis showed that there was a moderate level of between-country heterogeneity in this association (I2 = 59.4%), with the strongest association observed in Russia (OR = 1.33, 95% CI = 1.15-1.55). Conclusion: If our study results are confirmed in prospective studies, addressing perceived stress may have an impact in reducing the risk for MCI and subsequent dementia in LMICs.