Stress diagnoses in midlife and risk of dementia: a register-based follow-up study

Abstract

Objectives

Previous studies indicated that stress diagnoses increase the risk of dementia. However, previous results may be biased by confounding, reverse causation and misclassification. Therefore, the main aim of this study was to investigate the association between clinically diagnosed stress in midlife and later dementia risk, while addressing limitations of previous studies.

Methods

The study population was selected from all individuals in Denmark born 1935–1956. Individuals diagnosed with stress in midlife (aged 37–58 years) were matched (1:5) with individuals without stress diagnoses based on sex and birthdate (N = 103,484). Data were retrieved from national registers. Cox regression models were adjusted for socio-demographic factors and different morbidities.

Results

We found a 2.20 (95% CI: 1.93–2.50) times higher rate of dementia among individuals with any stress diagnosis registered in midlife compared with no stress diagnosis. Hazard rate ratios of dementia were 1.73 (95% CI: 1.13–2.65) among individuals with acute stress reactions, 2.37 (95% CI: 2.05–2.74) among individuals with adjustment disorders, and 2.20 (95% CI: 1.73–2.80) among individuals with unspecified stress reactions. Individuals with PTSD and other stress reactions had non-significantly elevated rates of dementia. Adjustment for confounding only slightly attenuated the association, and reverse causation did not appear to bias the results substantially.

Conclusion

Our results support the hypothesis that severe stress in midlife is an important risk factor for dementia. This finding emphasizes the importance of identifying and treating severe stress in midlife to reduce potential detrimental consequences for brain health in later life.

Keywords:

• Stress diagnosis
• dementia
• stress reaction
• post-traumatic stress disorder
• adjustment disorder

Acknowledgements

We are grateful for the prudent discussions and assistance from Elsebet Steno Hansen, Senior consultant, MD, PhD from Geriatric Psychiatric Department, Vordingborg, Region Zealand, regarding the inclusion and adjustment of relevant psychiatric ICD-8 diagnoses in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the VELUXFONDEN under Grant 00014847.