Severe stress reactions are implicated in neurodegenerative disease

  • Song H & al.
  • JAMA Neurol
  • 9 Mar 2020

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Individuals with severe psychiatric reactions induced by trauma or other life stressors have elevated risk for neurodegenerative diseases.

Why this matters

  • Underlying drivers, such as cerebrovascular factors, are possibly amenable to intervention.

Key results

  • At median 4.7 years, vs unexposed general population, individuals with stress-related disorders had increased adjusted risk for neurodegenerative diseases:
    • HR, 1.57 (95% CI, 1.43-1.73).
  • By disease group (HRs, 95% CIs):
    • Vascular neurodegenerative diseases: 1.80 (1.40-2.31).
    • Primary neurodegenerative diseases: 1.31 (1.15-1.48).
  • By disease (HRs; 95% CIs):
    • Alzheimer’s disease: 1.36 (1.12-1.67).
    • Any dementia: 1.80 (1.60-2.03).
    • Parkinson’s disease: 1.20 (0.98-1.47).
    • Amyotrophic lateral sclerosis: 1.20 (0.74-1.96).
  • Increased risk first seen ~2 years after start of follow-up, persisted for 20 years.
  • Findings similar with comparison against unaffected siblings.

Study design

  • Swedish nationwide retrospective cohort, individuals aged ≥40 years at study end:
    • 61,748 with first diagnosis of stress-related disorder (posttraumatic stress disorder, acute stress reaction, adjustment disorder, other);
    • 595,335 unexposed matched members of general population; and
    • 78,482 unexposed matched siblings.
  • Main outcome: incident neurodegenerative disease (starting from age of 40 years or 5 years postdiagnosis).
  • Funding: Swedish Research Council; others.

Limitations

  • Potential reverse causation, surveillance bias.
  • Possible misclassification of some unexposed.
  • Stress-related disorders not validated.