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Associations of salivary cortisol with cognitive function in the Baltimore memory study.

Lee-BK; Glass-TA; McAtee-MJ; Wand-GS; Bandeen-Roche-K; Bolla-KI; Schwartz-BS
Arch Gen Psychiatry 2007 Jul; 64(7):810-818
Context: The stress responses of the hypothalamic-pituitary-adrenal axis can produce adverse effects on the brain. Previous studies have concluded that an elevated level of cortisol is a risk factor for cognitive dysfunction and decline in aging but have been limited by sex exclusion, restricted cognitive batteries, and small sample sizes. Objective: To examine associations among salivary cortisol metrics and cognitive domain scores in an urban adult population. Design, Setting, and Participants: A cross-sectional analysis was conducted using data from a longitudinal study involving 1140 Baltimore, Maryland, residents aged 50 to 70 years. Four salivary cortisol samples were obtained from 967 participants across 1 study visit (before, during, and after cognitive testing as well as at the end of the visit) from which 7 cortisol metrics were created. We examined associations of cortisol metrics with cognitive performance using multiple linear regression. Main Outcome Measures: Performance on 20 standard cognitive tests was measured and combined to form summary measures in 7 domains (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, visual memory, and visuoconstruction). Results: Higher levels of pretest and mean cortisol as well as the area under the curve of cortisol over the study visit were associated with worse performance (P < .05) in 6 domains (language, processing speed, eye-hand coordination, executive functioning, verbal memory and learning, and visual memory). For instance, an interquartile range increase in the area under the curve was equivalent to a decrease in the language score expected from an increase in 5.6 (95% confidence interval, 4.2-7.1) years of age. Conclusions: Elevated cortisol was associated with poorer cognitive function across a range of domains in this large population-based study. We believe the findings are consistent with the hypothesis that hypothalamic-pituitary-adrenal axis dysregulation may be a risk factor for poorer cognitive performance in older persons.
Age-groups; Brain-disorders; Men; Women; Humans; Risk-factors; Neurological-system; Analytical-methods; Analytical-processes; Epidemiology; Diagnostic-tests
Brian S. Schwartz, MD, MS, Division of Occupational and Environmental Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room W7041, Baltimore, MD 21205
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Archives of General Psychiatry
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Johns Hopkins University