How stress affects cognitive health in older women and how to manage it?

How stress affects cognitive health in older women and how to manage it?

A recent research, published in the International Journal of Geriatric Psychiatry, conducted by John Hopkins School of Medicine researchers demonstrated that older women with midlife stress are at an increased risk of cognitive vulnerability than men1

It is well-known that women are at a greater risk of developing dementia and Alzheimer’s disease2. Furthermore, this uneven gender distribution has been attributed to differences in stress and subsequent stress hormone (cortisol) response3,4.

To substantiate this, Munro et al.1 designed a prospective Baltimore Epidemiologic Catchment Area (ECA) study that commenced in 1981 (Wave 1), which was further followed-up in 1982 (Wave 2), 1993-1996 (Wave 3), and 2003-2004 (Wave 4) in a sample of 909 (572 women and 337 men) Baltimore residents. 

The participants were interviewed at Wave 3 regarding having experienced recent (within the last year) and remote (between 1981 and 1 year ago) traumatic (combat, rape, accident, physical attack, mugging/theft, receiving threats, natural disasters, and witness to someone else being hurt/killed) and/or stressful (marriage, divorce/separation, birth of child, death of spouse/loved one, retirement, child moving out, loss of job and fatal injury/illness) life events. At Wave 3 and 4, they were also screened for global cognition (Mini-Mental State Examination) and auditory verbal learning and memory (word-list learning task; immediate and delayed word recall and recognition task).

The results of the Baltimore ECA study demonstrated an increased cognitive decline depicted by delayed word recall (B: -0.28; 95% CI, -0.56, -0.005) and recognition (B: -0.35; 95% CI, -0.68, -0.02) in women who experienced greater number of recent stressful life events, but not in men. 

The Baltimore ECA study is of particular significance as it elucidates uneven sex differences and the impact of stressors (at the age of 47-48 years) on subsequent cognitive decline (aged 57 years on an average) of middle-aged women. Since stress is related to higher cortisol response in women with acute stress and associated with poor memory function in older women4,5; stress and cortisol modulating interventions may help prevent cognitive decline in women.

Exercise or physical activity is one such common intervention and coping method that is known to alleviate the negative impact of stress, i.e., improvements in cortisol dysregulation and cognition in older adults. The beneficial effect of exercise is attributed to the changes in the diurnal cortisol secretion pattern and its positive effects on the hippocampus and prefrontal cortex6

Furthermore, the Essence of Chicken (EOC), a popular traditional supplement used in Asian countries is a unique remedy in managing stress by improving the metabolism of serum cortisol levels. This was demonstrated by Nagai et al.7 in their study of 20 subjects who administered EOC (140 ml) for 7 days. The mean pre-workload serum cortisol levels in the EOC and placebo group were 14.60 and 12.83 μg/100 ml, respectively. In EOC supplemented subjects, the cortisol level at rest normalized at a faster rate to 5.0-10.0 μg/100 ml, which also helped reduce mental stress quickly in these individuals.

The cognitive effects of stress, particularly in middle-aged women are worrisome. Therefore, it is of utmost importance to prevent cognitive decline induced by stress and stress hormone (cortisol). 


  1. Munro CA, Wennberg AM, Bienko N, Eaton WW, Lyketsos CG, Spira AP. Stressful life events and cognitive decline: Sex differences in the Baltimore Epidemiologic Catchment Area Follow-Up Study. International Journal of Geriatric Psychiatry. 2019;34(7):1008-1017. 
  2. Gao S, Hendrie HC, Hall KS, Hui S. The Relationships Between Age, Sex, and the Incidence of Dementia and Alzheimer Disease: A Meta-analysis. Archives of General Psychiatry. 1998;55(9):809–815.
  3. Munro CA. Sex differences in Alzheimer’s disease risk: are we looking at the wrong hormones? International Psychogeriatrics. 2014;26(10):1579-1584.
  4. Otte C, Hart S, Neylan TC, Marmar CR, Yaffe K, Mohr DC. A meta-analysis of cortisol response to challenge in human aging: importance of gender. Psychoneuroendocrinology. 2005;30(1):80-91.
  5. Almela M, Hidalgo V, Villada C, Espín L, Gómez‐Amor J, Salvador A. The impact of cortisol reactivity to acute stress on memory: sex differences in middle‐aged people. Stress. 2011;14(2): 117‐127.
  6. Tortosa-Martinez J, Manchado C, Cortell-Tormo JM, Chulvi-Medrano I. exercise, the diurnal cycle of cortisol and cognitive impairment in older adults. Neurobiology of Stress. 2018;9:40-47. 
  7. Nagai H, Harada M, Nakagawa M, Tanaka T, Gunadi B, Setiabudi ML, Uktolseja JL, Miyata Y. effects of chicken extract on the recovery from fatigue caused by mental workload. Applied Human Science: Journal of Physiological Anthropology. 1996;15(6):281-286.