Introduction: Previous studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. This study investigated the relationship between perceived stress and MCR in a community-based population. Methods: The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of subjective memory complaints (SMCs) and slow gait speed. Results: The average age of the study participants is 79.84 ± 4.34 years. The mean score of PSS-10 among participants is 10.32 (range = 0–33; [SD] = 5.71), with a median score of 10.00 (6.00, 14.00). The prevalence of MCR is 9.3%. In the logistic regression analysis, for each 1-SD (5.71) increase in the global PSS-10 score, the risk of MCR increased by 40% (95% CI 1.09–1.80). Additionally, in the aspect of two components of MCR, with a 1-SD increase (5.71) in the global PSS-10 score, there was a 50% (95% CI 1.29–1.75) increase in the risk of SMCs and a 27% (95% CI 1.04–1.55) increase in the risk of slow gait speed. In terms of specific walking speed, there was a reverse correlation between the global PSS-10 score and walking speed (r = −0.14, p < 0.001). Conclusions: This study provided preliminary evidence that high levels of perceived stress were associated with the risk of MCR in a community-dwelling population.

Previous studies have indicated a correlation between perceived stress and cognitive decline. However, it remains unknown whether high levels of perceived stress can result in motoric cognitive risk (MCR) syndrome. Perceived stress has been defined as the result of a series of environmental events and demands (stressors) perceived by an individual as exceeding their subjective capacity to cope. MCR syndrome is a novel pre-dementia syndrome consisting of subjective memory complaints (SMCs) and slow gait speed. MCR syndrome is a public health problem with a prevalence of 6.3–9.6% in community-dwelling elderly populations in different countries. It is important to identify and treat risk factors for MCR. This will help prevent MCR in order to prevent dementia at an early stage. This study investigated the relationship between perceived stress and MCR in a community-based population. The study cohort comprised 852 elderly individuals from the Rugao Longitudinal Aging Cohort. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10), while MCR was defined as the coexistence of SMCs and slow gait speed. In conclusion, we discovered a significant association between high levels of perceived stress and an increased risk of MCR among individuals aged 70 and older in the community.

Motoric cognitive risk (MCR) syndrome is a novel pre-dementia syndrome consisting of subjective memory complaints (SMCs) and slow gait speed [1]. MCR is a public health problem with a prevalence of 6.3–9.6% in community-dwelling elderly populations in different countries [2, 3]. It is important to identify and treat risk factors for MCR. This will help prevent MCR in order to prevent dementia at an early stage. Some risk factors for MCR have been reported, including low education [4], low physical activity [5], poor social support [6], and depression [7].

Stress has been defined as the result of a series of environmental events and demands (stressors) perceived by an individual as exceeding their subjective capacity to cope [8]. Many studies have shown that a high level of perceived stress increases the risk of adverse outcomes such as cancer [9, 10], coronary artery disease [11], stroke [12‒14], and mortality [15, 16]. Furthermore, it has been indicated that increased levels of perceived stress are associated with cognitive decline in one of the components of the MCR [17‒20]. It has also been suggested that elevated levels of perceived stress may be associated with a reduction in physical activity, a similar phenotype to slow gait speed, another component of the MCR [21‒23]. Therefore, perceived stress may be a potential risk factor for MCR and could be applied to prevent it.

Few studies have reported the relationship between perceived stress and MCR. Given that early prevention of MCR may help prevent dementia, it is necessary to investigate the potential relationship between perceived stress and MCR. In this study, our aim was to investigate the relationship between perceived stress and MCR in a community-dwelling population.

Participants

The present study utilized data from the Rugao Longevity and Aging Study (RuLAS), an aging cohort established in 2014. At baseline, approximately 1,960 elderly individuals were recruited, with the fourth follow-up conducted in 2021 [24]. This investigation focused on participants from the fourth follow-up survey of RuLAS, resulting in the inclusion of 852 individuals. All participants provided complete cognitive and gait speed data, except for those with a history of Parkinson’s disease, depression, dementia, severe cognitive impairment, or limitations in basic activities of daily living [25]. Moreover, individuals with a history of myocardial infarction, cancer, cerebral hemorrhage, or cerebral infarction were subsequently excluded from the analysis.

Perceived Stress

Perceived stress was measured through Cohen’s Perceived Stress Scale (PSS), a tool devised to assess an individual’s evaluation of stressful occurrences encountered during the previous month [26]. The 10-item version of the PSS was used in this investigation, which has been demonstrated to be robust in terms of reliability and validity in previous validation studies (Cronbach’s alpha = 0.75) [27]. Moreover, the PSS-10 demonstrates superior internal consistency when measuring the elderly population in comparison to other versions of the PSS [28]. The global score on the PSS-10 is calculated after reversing the scores on the positive items. Scores on the PSS-10 range from 0 to 40, with higher scores indicating a greater level of perceived stress during the month.

MCR Syndrome Criteria

MCR syndrome was defined as the coexistence of SMCs and slow gait speed in elderly individuals without dementia or mobility disabilities [1]. SMCs were determined by the response to the question, “Do you think your memory is worse than that of most people?” from the 15-item Geriatric Depression Scale (GDS-15) [29], administered by a physician or nurse. Participants responding affirmatively to this question were classified as having SMCs. Gait speed was assessed by instructing participants to walk a distance of 5 m at their normal pace. Slow gait speed was operationally defined as a gait speed below one standard deviation of the mean gait speed for the participant’s group, after stratification by age and gender [30, 31]. In this study, the cut-off values for slow gait speed were as follows: males ≤74 years old, ≤0.83 m/s; males aged 75–79, ≤0.78 m/s; males aged 80–84, ≤0.74 m/s; males ≥85 years old, ≤0.60 m/s; females ≤74 years old, ≤0.85 m/s; females aged 75–79, ≤0.68 m/s; females aged 80–84, ≤0.64 m/s; females ≥85 years old, ≤0.57 m/s.

Covariates

Covariates included age, sex (male; female), occupation (farmer; other), marital status (married; other), educational level (illiterate; literate), smoking status (smoking defined as daily consumption of one or more cigarettes within the past 6 months; categorized as never/ever/current smoker), alcohol consumption status (alcohol consumption defined as daily intake of 50 mL of alcohol-containing beverages within the past 6 months; categorized as never/ever/current drinker), body mass index (<28 kg/m2 or ≥28 kg/m2) [32], diabetes, and hypertension. Diabetes was defined as having a history of diabetes, using any anti-diabetic medications, or having a fasting blood glucose level exceeding 7.0 mmol/L. Hypertension was defined as having a history of hypertension, using any antihypertensive medications, or having an average blood pressure higher than 140/90 mm Hg. Depressive symptoms were measured with the 5-item Geriatric Depression Scale (GDS-5). The scale consists of 5 items covering depressive symptomatology. Each item is answered with “yes” or “no,” and a score of 1 is given for “yes” and 0 for “no.” A total score of 2 or higher indicates the presence of depressive symptoms [33].

Statistical Analysis

Continuous variables were reported as mean ± standard deviation (SD) or as median with interquartile range (IQR), while categorical variables were expressed as percentages. Differences in participant characteristics between the MCR and non-MCR groups were assessed using t tests or χ2 tests, as appropriate based on the data type.

The relationship between perceived stress and MCR was evaluated using logistic regression models. Further exploration of the association between perceived stress and specific walking speeds was conducted using Pearson correlation analysis. Model 1 was not adjusted for any confounding factors. Model 2 was adjusted for age and gender. Model 3 was adjusted for all covariates in Model 2 and demographic, lifestyle, and disease factors, including occupation, educational level, marital status, smoking status, alcohol consumption status, obesity, diabetes, and hypertension. Model 4 was adjusted for all covariates in Model 3 and depressive symptoms.

Odds ratios (OR) and their corresponding 95% confidence intervals (95% CI) were reported. The level of statistical significance for all analyses was set at p < 0.05. All statistical analyses were conducted using Rx64 4.0.2 (“https://www.r-project.org/”).

Characteristics of the Study Population

A total of 852 participants were included in this study, with a mean age of 79.84 ± 4.34 years. The mean perceived stress score among participants was 10.32 (range = 0–33; [SD] = 5.71), and the median score was 10.00 (IQR = 6.00, 14.00). The prevalence of MCR syndrome was 9.3%. In comparison to the non-MCR group, the MCR group exhibited a higher mean age (81.16 vs. 79.70), a higher prevalence of individuals without formal education (55% vs. 36%), and a higher prevalence of individuals without a spouse (53% vs. 35%). Among all participants, 78.3% were engaged in farming; the majority (92.8%) did not have diabetes; the obesity prevalence was 10.6%; and the hypertension prevalence was 43.8% (Table 1).

Table 1.

Demographic characteristics of participants by MCR status

CharacteristicsAll (n = 852)Non-MCR (n = 772)MCR (n = 80)p value
Age, years 79.84±4.34 79.70±4.37 81.16±3.86 0.004** 
Sex    0.394 
 Male 438 (0.51) 401 (0.52) 37 (0.46)  
 Female 414 (0.49) 371 (0.48) 43 (0.54)  
Education    <0.001*** 
 Illiterate 325 (0.38) 281 (0.36) 44 (0.55)  
 Literate 495 (0.58) 464 (0.60) 31 (0.39)  
Occupation    0.216 
 Farmer 667 (0.78) 599 (0.78) 68 (0.85)  
 Other 165 (0.19) 154 (0.20) 11 (0.14)  
Marital status    0.003** 
 Currently married 517 (0.61) 480 (0.62) 37 (0.46)  
 Other 309 (0.36) 267 (0.35) 42 (0.53)  
Smoking    0.91 
 Never 624 (0.73) 564 (0.73) 60 (0.75)  
 Former 72 (0.08) 65 (0.08) 7 (0.09)  
 Current 153 (0.18) 140 (0.18) 13 (0.16)  
Drinking    0.609 
 Never 533 (0.63) 481 (0.62) 52 (0.65)  
 Former 80 (0.09) 71 (0.09) 9 (0.11)  
 Current 239 (0.28) 220 (0.28) 19 (0.24)  
Obesity    0.244 
 No 762 (0.89) 694 (0.90) 68 (0.85)  
 Yes 90 (0.11) 78 (0.10) 12 (0.15)  
Diabetes    1.000 
 No 791 (0.93) 717 (0.93) 74 (0.93)  
 Yes 61 (0.07) 55 (0.07) 6 (0.08)  
Hypertension    0.410 
 No 479 (0.56) 438 (0.57) 41 (0.51)  
 Yes 373 (0.44) 334 (0.43) 39 (0.49)  
Depressive symptoms    0.752 
 No 780 (0.93) 707 (0.93) 73 (0.91)  
 Yes 61 (0.07) 54 (0.07) 7 (0.09)  
PSS-10 global score    0.008** 
 Median with IQR 10.00 (6.00, 14.00) 10.00 (6.00, 14.00) 12.00 (8.00, 15.00)  
 M±SD 10.32±5.71 10.15±5.68 11.93±5.70  
CharacteristicsAll (n = 852)Non-MCR (n = 772)MCR (n = 80)p value
Age, years 79.84±4.34 79.70±4.37 81.16±3.86 0.004** 
Sex    0.394 
 Male 438 (0.51) 401 (0.52) 37 (0.46)  
 Female 414 (0.49) 371 (0.48) 43 (0.54)  
Education    <0.001*** 
 Illiterate 325 (0.38) 281 (0.36) 44 (0.55)  
 Literate 495 (0.58) 464 (0.60) 31 (0.39)  
Occupation    0.216 
 Farmer 667 (0.78) 599 (0.78) 68 (0.85)  
 Other 165 (0.19) 154 (0.20) 11 (0.14)  
Marital status    0.003** 
 Currently married 517 (0.61) 480 (0.62) 37 (0.46)  
 Other 309 (0.36) 267 (0.35) 42 (0.53)  
Smoking    0.91 
 Never 624 (0.73) 564 (0.73) 60 (0.75)  
 Former 72 (0.08) 65 (0.08) 7 (0.09)  
 Current 153 (0.18) 140 (0.18) 13 (0.16)  
Drinking    0.609 
 Never 533 (0.63) 481 (0.62) 52 (0.65)  
 Former 80 (0.09) 71 (0.09) 9 (0.11)  
 Current 239 (0.28) 220 (0.28) 19 (0.24)  
Obesity    0.244 
 No 762 (0.89) 694 (0.90) 68 (0.85)  
 Yes 90 (0.11) 78 (0.10) 12 (0.15)  
Diabetes    1.000 
 No 791 (0.93) 717 (0.93) 74 (0.93)  
 Yes 61 (0.07) 55 (0.07) 6 (0.08)  
Hypertension    0.410 
 No 479 (0.56) 438 (0.57) 41 (0.51)  
 Yes 373 (0.44) 334 (0.43) 39 (0.49)  
Depressive symptoms    0.752 
 No 780 (0.93) 707 (0.93) 73 (0.91)  
 Yes 61 (0.07) 54 (0.07) 7 (0.09)  
PSS-10 global score    0.008** 
 Median with IQR 10.00 (6.00, 14.00) 10.00 (6.00, 14.00) 12.00 (8.00, 15.00)  
 M±SD 10.32±5.71 10.15±5.68 11.93±5.70  

*p < 0.05, **p < 0.01, ***p < 0.001.

Associations of Perceived Stress with MCR Syndrome

In comparison to the normal group, the MCR group exhibited higher median (12 vs. 10) and mean (11.93 vs. 10.15) perceived stress scores for the PSS-10 (Table 1). With each incremental increase of 1 point in the PSS-10 score, the risk of MCR increased by 6% (95% CI 1.01–1.10). After adjusting for multiple potential confounders, including age, sex, occupation, education, marital status, smoking, alcohol consumption, obesity, diabetes, and hypertension, a significant correlation remained. The risk of MCR increased by 49% (95% CI 1.12–1.98) for every tertile increase in the PSS-10 score and by 40% (95% CI 1.09–1.80) for each 1-SD (5.71) increase in the PSS-10 score (Table 2).

Table 2.

Associations between perceived stress and MCR status by logistic regression analysis

Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.055 (1.014∼1.098) 0.008** 1.046 (1.005∼1.089) 0.028* 1.049 (1.005∼1.095) 0.030* 1.048 (1.004∼1.095) 0.032* 
T1 (≤8) Reference        
T2 (>8, ≤13) 1.751 (0.969∼3.204)  1.715 (0.946∼3.145)  1.731 (0.920∼3.300)  1.736 (0.921∼3.315)  
T3 (>13) 2.247 (1.271∼4.052)  2.040 (1.146∼3.700)  2.027 (1.099∼3.819)  2.039 (1.104∼3.844)  
Per unit increase 1.486 (1.124∼1.975) 0.006** 1.415 (1.068∼1.885) 0.016* 1.409 (1.045∼1.911) 0.026* 1.413 (1.047∼1.917) 0.025* 
Per SD increase 1.403 (1.094∼1.803) 0.008** 1.329 (1.034∼1.713) 0.027* 1.329 (1.019∼1.740) 0.037* 1.324 (1.013∼1.734) 0.040* 
Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.055 (1.014∼1.098) 0.008** 1.046 (1.005∼1.089) 0.028* 1.049 (1.005∼1.095) 0.030* 1.048 (1.004∼1.095) 0.032* 
T1 (≤8) Reference        
T2 (>8, ≤13) 1.751 (0.969∼3.204)  1.715 (0.946∼3.145)  1.731 (0.920∼3.300)  1.736 (0.921∼3.315)  
T3 (>13) 2.247 (1.271∼4.052)  2.040 (1.146∼3.700)  2.027 (1.099∼3.819)  2.039 (1.104∼3.844)  
Per unit increase 1.486 (1.124∼1.975) 0.006** 1.415 (1.068∼1.885) 0.016* 1.409 (1.045∼1.911) 0.026* 1.413 (1.047∼1.917) 0.025* 
Per SD increase 1.403 (1.094∼1.803) 0.008** 1.329 (1.034∼1.713) 0.027* 1.329 (1.019∼1.740) 0.037* 1.324 (1.013∼1.734) 0.040* 

Model 1 adjusted for age and gender on crude model.

Model 2 adjusted for smoking, drinking, education, marital status, occupation, diabetes, hypertension, BMI category plus the variables in Model 1.

Model 3 adjusted for depressive symptoms plus the variables in Model 2. *p < 0.05, **p < 0.01, ***p < 0.001.

Associations of Perceived Stress with Subjective Cognitive Decline

For the SMCs component of MCR, for each incremental increase of 1 point in the PSS-10 score, the risk of SMCs increased by 7% (OR = 1.07, 95% CI 1.05–1.10). After adjusting for confounding factors, a significant association persisted. Risk increased by 53% (95% CI 1.29–1.80) for each tertile increase in the PSS-10 score and by 50% (95% CI 1.29–1.75) for each 1-SD (5.71) increase in the PSS-10 score (Table 3).

Table 3.

Associations between perceived stress and SMCs status by logistic regression analysis

Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.072 (1.046∼1.099) <0.001*** 1.069 (1.043∼1.097) <0.001*** 1.072 (1.044∼1.101) <0.001*** 1.069 (1.040∼1.099) <0.001*** 
T1 (≤8) Reference 
T2 (>8, ≤13) 1.860 (1.342∼2.585)  1.865 (1.343∼2.598)  2.075 (1.456∼2.968)  2.093 (1.462∼3.007)  
T3 (>13) 2.285 (1.639∼3.197)  2.208 (1.577∼3.102)  2.253 (1.569∼3.248)  2.213 (1.535∼3.202)  
Per unit increase 1.525 (1.292∼1.803) <0.001*** 1.501 (1.270∼1.778) <0.001*** 1.523 (1.272∼1.827) <0.001*** 1.511 (1.259∼1.816) <0.001*** 
Per SD increase 1.498 (1.289∼1.745) <0.001*** 1.467 (1.260∼1.713) <0.001*** 1.490 (1.265∼1.762) <0.001*** 1.456 (1.233∼1.723) <0.001*** 
Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.072 (1.046∼1.099) <0.001*** 1.069 (1.043∼1.097) <0.001*** 1.072 (1.044∼1.101) <0.001*** 1.069 (1.040∼1.099) <0.001*** 
T1 (≤8) Reference 
T2 (>8, ≤13) 1.860 (1.342∼2.585)  1.865 (1.343∼2.598)  2.075 (1.456∼2.968)  2.093 (1.462∼3.007)  
T3 (>13) 2.285 (1.639∼3.197)  2.208 (1.577∼3.102)  2.253 (1.569∼3.248)  2.213 (1.535∼3.202)  
Per unit increase 1.525 (1.292∼1.803) <0.001*** 1.501 (1.270∼1.778) <0.001*** 1.523 (1.272∼1.827) <0.001*** 1.511 (1.259∼1.816) <0.001*** 
Per SD increase 1.498 (1.289∼1.745) <0.001*** 1.467 (1.260∼1.713) <0.001*** 1.490 (1.265∼1.762) <0.001*** 1.456 (1.233∼1.723) <0.001*** 

Model 1 adjusted for age and gender on crude model.

Model 2 adjusted for smoking, drinking, education, marital status, occupation, diabetes, hypertension, BMI category plus the variables in Model 1.

Model 3 adjusted for depressive symptoms plus the variables in Model 2. *p < 0.05, **p < 0.01, ***p < 0.001.

Associations of Perceived Stress with Slow Gait

For the slow gait speed component of MCR, logistic regression analysis revealed that with every 1-point increase in the PSS-10 score, the risk of slow gait increased by 4% (OR = 1.04, 95% CI 1.01–1.07). For each 1-SD (5.71) increase in the PSS-10 score, the risk of slow gait increased by 27% (95% CI 1.04–1.55). Even after adjusting for confounding factors, a significant relationship persisted. In the crude model, for each tertile increase in the PSS-10 score, the risk of slow gait increased by 32% (95% CI 1.06–1.80). However, as adjustment variables increased, the odds ratio weakened and no longer had statistical significance (Table 4). Furthermore, the results (shown in Fig. 1) indicated a reverse correlation between PSS-10 scores and specific walking speeds (r = −0.14, p < 0.001).

Table 4.

Associations between perceived stress and slow gait status by logistic regression analysis

Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.040 (1.007∼1.074) 0.016* 1.034 (1.001∼1.068) 0.043* 1.037 (1.002∼1.074) 0.040* 1.039 (1.004∼1.076) 0.030* 
T1 (≤8) Reference 
T2 (>8, ≤13) 1.641 (1.045∼2.588)  1.623 (1.031∼2.564)  1.475 (0.909∼2.397)  1.514 (0.932∼2.465)  
T3 (>13) 1.747 (1.111∼2.759)  1.630 (1.031∼2.586)  1.591 (0.981∼2.588)  1.624 (1.000∼2.646)  
Per unit increase 1.319 (1.058∼1.647) 0.014* 1.274 (1.019∼1.595) 0.034* 1.248 (0.985∼1.582) 0.056 1.261 (0.994∼1.601) 0.047* 
Per SD increase 1.267 (1.040∼1.545) 0.019* 1.217 (0.997∼1.488) 0.054 1.254 (1.013∼1.555) 0.038* 1.270 (1.025∼1.577) 0.029* 
Perceived stressCrude modelModel 1Model 2Model 3
OR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p value
Global score 1.040 (1.007∼1.074) 0.016* 1.034 (1.001∼1.068) 0.043* 1.037 (1.002∼1.074) 0.040* 1.039 (1.004∼1.076) 0.030* 
T1 (≤8) Reference 
T2 (>8, ≤13) 1.641 (1.045∼2.588)  1.623 (1.031∼2.564)  1.475 (0.909∼2.397)  1.514 (0.932∼2.465)  
T3 (>13) 1.747 (1.111∼2.759)  1.630 (1.031∼2.586)  1.591 (0.981∼2.588)  1.624 (1.000∼2.646)  
Per unit increase 1.319 (1.058∼1.647) 0.014* 1.274 (1.019∼1.595) 0.034* 1.248 (0.985∼1.582) 0.056 1.261 (0.994∼1.601) 0.047* 
Per SD increase 1.267 (1.040∼1.545) 0.019* 1.217 (0.997∼1.488) 0.054 1.254 (1.013∼1.555) 0.038* 1.270 (1.025∼1.577) 0.029* 

Model 1 adjusted for age and gender on crude model.

Model 2 adjusted for smoking, drinking, education, marital status, occupation, diabetes, hypertension, BMI category plus the variables in Model 1.

Model 3 adjusted for depressive symptoms plus the variables in Model 2. *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 1.

Pearson correlation analysis between PSS-10 scores and specific walking speeds.

Fig. 1.

Pearson correlation analysis between PSS-10 scores and specific walking speeds.

Close modal

This study demonstrates, for the first time, that higher levels of perceived stress, as measured by the PSS-10, are associated with an increased risk of MCR. Additionally, this study reports a novel association between higher levels of perceived stress and an increased risk of slow gait speed. Furthermore, there is a significant inverse association between PSS-10 scores and specific gait speeds.

For perceived stress, the median PSS-10 score among the 852 participants in this study was 10.00 (IQR 6.00, 14.00), with a mean of 10.32 (range = 0–33; standard deviation [SD] = 5.71), consistent with findings from previous studies involving elderly populations [34]. Regarding MCR, the prevalence of MCR was 9.3% among the participants in this study, which is within a similar range to the prevalence of 6.3–9.6% observed in community-dwelling elderly populations in different countries [2, 3].

We examined the association between perceived stress and MCR from multiple perspectives (per 1-point increase/per tertile unit increase/per 1-SD increase in PSS-10 scores), and the results all suggest that higher levels of perceived stress are associated with an increased risk of MCR. As no previous reports have investigated the connection between perceived stress and MCR, our study is the first to reveal that higher levels of perceived stress are linked to an increased risk of MCR. This discovery highlights the importance of taking perceived stress into account when developing strategies for MCR prevention.

In terms of the relationship between perceived stress and the cognitive component of the MCR, namely SMCs, three population-based studies from the Longitudinal Aging Study Amsterdam (LASA) in the Netherlands [17], the Minority Aging Research Study (MARS) in the USA [18], and the Population Study of Chinese Elderly (PINE) in Chicago [19] suggest that participants who reported higher levels of perceived stress had worse cognitive function compared to those with lower levels of perceived stress. Another report investigating the association between perceived stress and mild cognitive impairment (MCI) in six low- and middle-income countries found that the prevalence of MCI increased with high levels of perceived stress [20]. The results of this study were similar to their observations, and we extended the associations to SMC status, which is even more clinically relevant since it could be a reversible condition when timely intervention occurs.

Only three studies from student populations have suggested that an increase in perceived stress is associated with a reduction in physical activity [21‒23], and fewer studies have explored the relationship between perceived stress and slow gait speed, which is another component of the MCR. This study is the first to find that higher levels of perceived stress are associated with a higher risk of slow gait speed in a community-dwelling population, and we extend this finding by revealing that there is a reverse association with specific walking speed (r = −0.14, p < 0.001).

Several potential mechanisms may help explain the connection between perceived stress and MCR. (1) Higher levels of perceived stress may lead to immune system dysregulation [35], increased production of pro-inflammatory cytokines [36], and systemic inflammation [37, 38]. In cognitive component of MCR, elevated inflammation levels can increase the risk of dementia [39]. In physical component of MCR, elevated inflammation levels can lead to a subsequent decline in walking speed [40], thereby promoting MCR development. (2) Higher perceived stress may influence cognitive performance through the regulation of the HPA axis function [41], thereby contribute to the pathogenesis of MCR. (3) The impact of perceived stress on cognition may be influenced by personality and the underlying neurologic mechanisms. Individuals with susceptible personality traits are more likely to be affected by stress-induced cognitive decline, thereby leading to the development of MCR [42]. In future studies, exploring whether these factors mediate the association between perceived stress and MCR among participants is needed.

The limitations of this study need to be mentioned. The cross-sectional nature of this study prohibits causal inference since the relationship between perceived stress and MCR may be bidirectional. In addition, we did not measure the polysomnographic parameters in our cohort. Therefore, we could not acquire an objective sleep-related index to assist in the assessment of perceived stress. Lastly, although we took into account various potential confounding factors and clinical characteristics in our analyses, it is still possible that there are some residual confounding factors that we were unable to completely eliminate.

We discovered a significant association between high levels of perceived stress and an increased risk of MCR among individuals aged 70 and older in the community. Furthermore, the impact of perceived stress on MCR risk necessitates further validation through longitudinal studies involving elderly populations within this age group. Further research studies are needed to verify whether stress-reduction interventions may influence the development of MCR, hence yielding greater practical significance.

We acknowledge all participants involved in the present study from the Rugao Aging Cohort. We acknowledge the support from the government of Rugao, the Public Health Bureau of Jiang’an township and Rugao city, the Bureau of Civil Affairs, the Rugao People’s Hospital, and all the local village physicians.

The Human Ethics Committee of the School of Life Sciences of Fudan University, Shanghai, China, approved this research (No: BE1815). Written informed consent was obtained from all participants prior to participation.

The authors declare no conflict of interest.

This work was supported by grants from the Shanghai Municipal Science and Technology Major Project (2017SHZDZX01), the Shanghai Clinical Research Center for Aging and Medicine (19MC1910500), and the National Key R&D Program of China (2018YFC2000400, 2018YFC2000400-3, 2018YFC2002000).

Yuan-Fei Cao, Guo-Ping Shi, Jiang-Hong Guo, and Xiao-Feng Wang: study design, interpretation of results, and preparation and editing of the manuscript. Yuan-Fei Cao and Xiao-Feng Wang: data analysis. Yuan-Fei Cao, Guo-Ping Shi, Hui Zhang, Meng-Zhen Sun, Zheng-Dong Wang, Xue-Feng Chu, Jiang-Hong Guo, and Xiao-Feng Wang: data collection. All authors were involved in the preparation of the manuscript and final approval of the submitted and published versions.

Additional Information

Yuan-Fei Cao and Guo-Ping Shi are co-first authors.

All data are fully available without restriction. Further inquiries can be directed to the corresponding author.

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