Wolff Schlotz

Salivary Cortisol in Ambulatory Assessment--Some Dos, Some Don'ts, and Some Open Questions

The impact of stress on health and disease is an important research topic in psychosomatic medicine. Because research on hypothalamic-pituitary-adrenal (HPA) axis regulation under controlled laboratory studies lacks ecological validity, it needs to be complemented by a research program that includes momentary ambulatory assessment. The measurement of salivary cortisol offers the possibility to trace the free steroid hormone concentrations in ambulant settings. Therefore, in this article, we first discuss the role of salivary cortisol in ambulatory monitoring. We start with a brief description of HPA axis regulation, and we then consider cortisol assessments in other organic materials, followed by a presentation of common salivary markers of HPA axis regulation suitable for ambulatory assessment. We further provide an overview on assessment designs and sources of variability within and between subjects (intervening variables), acknowledge the issue of (non)compliance, and address statistical aspects. We further give an overview of associations with psychosocial and health-related variables relevant for ambulatory assessment. Finally, we deal with preanalytical aspects of laboratory salivary cortisol analysis. The relative simplicity of salivary cortisol assessment protocols may lead to an overoptimistic view of the robustness of this method. We thus discuss several important issues related to the collection and storage of saliva samples and present empirical data on the stability of salivary cortisol measurements over time.

Longitudinal studies using a “Natural Experiment” Design: The case of adoptees from Romanian institutions

OBJECTIVEnTo summarize the advantages and limitations of general population, high-risk and natural experiment longitudinal studies for studying psychological change. The English and Romanian Adoptees study is used as an example of a natural experiment, and detailed findings are provided.nnnMETHODnWhat is new is a focus on the young people who spent the whole of their life in institutional care up to the time of adoption and who did not show subnutrition. The results were compared with a composite comparison group who had not experienced institutional care or who were adopted before the age of 6 months. The outcomes were assessed in terms of previously established deprivation-specific patterns (DSPs).nnnRESULTSnPure psychosocial deprivation was associated with a substantial increase in the rate of DSPs. It was not associated with significantly impaired head growth if institutional care lasted less than 6 months, whereas thereafter there was a 2.5 standard deviation reduction. Subnutrition differed in being accompanied by impaired head and body growth even with institutional care lasting less than 6 months. In the pure psychosocial deprivation group, 45.5% showed a DSP at 15 years compared with 1.3% in the comparison group.nnnCONCLUSIONnPure psychosocial deprivation (in the absence of subnutrition) had a profound effect on psychological functioning in the form of DSPs. Subnutrition had a surprisingly small effect on DSPs.

Specific associations of insulin resistance with impaired health-related quality of life in the Hertfordshire Cohort Study

Insulin resistance is a metabolic abnormality that underlies Type 2 diabetes, the metabolic syndrome and cardiovascular disease, but it may also be associated with more global health deficits. This study assessed associations of insulin resistance with health-related quality of life (HRQoL) in different domains of physical and mental health in a large elderly population study. Cross-sectional data of 1212 participants from the Hertfordshire Cohort Study were analysed. Insulin resistance was assessed by the homeostatic model assessment (HOMA-IR), and HRQoL was measured using the SF-36 health survey. Poor HRQoL was defined by a score lower than the sex-specific 10th percentile of each scale, and logistic regressions yielded odds ratios in relation to the HOMA-IR scores. Subsequent analyses adjusted for the influence of age, smoking, alcohol consumption, social class, BMI, coronary heart disease and depression. Results showed an increase in poor HRQoL with an increase in HOMA-IR scores for physical functioning (ORxa0=xa02.29; CI: 1.67–3.13), vitality (ORxa0=xa01.45; CI: 1.05–2.00), and general health (ORxa0=xa01.62; CI: 1.19–2.21). In men, but not in women, associations with physical functioning were independent of confounding variables. The results indicate that insulin resistance is associated with poor HRQoL in domains of physical health, but not in domains of mental health.

Arbeitsstress, sozialer Stress und Schlafqualität:

Cross-sectional analyses of data from 309 subjects test two hypotheses: (1) Sleep disorders are related to social stress, not work stress, and (2) the personality trait “worry disposition” reveals a direct as well as an indirect, i.e. stress-mediated, effect on sleep disorders. A negative association of sleep quality to social stress, but not work stress is found after controlling for effects of worry, age, and illness frequency. This finding is confirmed by the findings of a subsequent path analysis. A subsequent longitudinal study tests hypothesis (3): Social stress causes impairments in sleep quality. Seventy-six subjects received handheld-computers to measure sleep quality and stress in different domains on two subsequent days. A cross-lagged panel analysis reveals associations of social stress at the first day to sleep quality at the second day, but no reversed relation. Findings point to the relevance of worry disposition and social stress in explaining sleep disorders. An 309 Probanden werden in einer Querschnittsuntersuchung zwei Hypothesen uberpruft: (1) Schlafstorungen hangen mit sozialem Stress zusammen, nicht mit Arbeitsstress und (2) das Personmerkmal Besorgnisneigung hat sowohl einen direkten als auch einen indirekten, uber Stress vermittelten, Effekt auf Schlafstorungen. Nach statistischer Kontrolle der Variablen Besorgnisneigung, Alter und Krankheitshaufigkeit findet sich neben anderen Ergebnissen ein negativer Zusammenhang von Schlafqualitat mit sozialem Stress, nicht aber mit Arbeitsstress. Dieser Befund kann in einer anschliesenden Pfadanalyse bestatigt werden. In einer Langsschnittuntersuchung wird dann Hypothese (3) uberpruft: Sozialer Stress verursacht Beeintrachtigungen der Schlafzufriedenheit. 76 Versuchsteilnehmern wurden Handheld-Computer ausgehandigt, die an zwei aufeinanderfolgenden Tagen Schlafzufriedenheit und verschiedene Arten der Beanspruchung erfassten. Eine crossed-lagged Panel Analyse zeigt einen Zusammenhang von sozialem Stress am ersten Tag mit Schlafzufriedenheit am zweiten Tag, aber keinen umgekehrten Zusammenhang. Die Ergebnisse weisen auf die Bedeutung von Besorgnisneigung und sozialem Stress fur die Erklarung von Schlafstorungen hin.

Birth weight and perceived stress reactivity in older age

Stress reactivity is a disposition that underlies individual differences in stress responses, thereby affecting vulnerability for the development of disease. Besides genetic and early postnatal environmental factors, stress reactivity has been shown to be influenced by an adverse prenatal developmental environment, but it is unclear if such effects persist into older age. We tested associations between fetal growth and perceived stress reactivity in 421 participants from the Hertfordshire Cohort at age 66-75u2009years. Regression analysis showed a U-shaped association between birth weight and perceived stress reactivity with increased levels of stress reactivity at the lower and upper end of the birth weight distribution. These effects were stable after adjustment for markers of early adversity and recent adversity and chronic stress. Although the effects were small, they are consistent with findings from studies in younger cohorts, and demonstrate that such effects can persist into older age.

58. Systemic inflammatory responses to stress and its impact on cognition in subjects with Mild Cognitive Impairment

Subjects with amnestic Mild Cognitive Impairment (aMCI) do not inevitably show cognitive decline or convert to Alzheimer’s disease supporting the hypothesis that secondary events are crucial in the conversion process. The study purpose is to examine whether stress (psychological and physical) contributes to the worsening of cognitive decline in aMCI subjects due to the prolonged stress-induced production of pro-inflammatory cytokines. This is an observational study assessing the association between cognitive decline and the degree of stress in 140 aMCI subjects and 70 control subjects. The primary hypothesis is that psychological stress, as measured by the RLCQ, is associated with worsened cognitive decline, as measured by the FCSRT-IR, over an 18xa0month period. Secondary outcomes include difference in change of score in the TMT, Verbal Fluency test, MoCA, DSST, GDS, and the Sickness Behaviour Scale. Other exploratory measures of stress include salivary cortisol levels, the PSS, CSSS, and physical stressors including infections. Biological outcomes include changes in blood levels of inflammatory markers and immunophenotyping of peripheral blood mononuclear cells. To date 62 subjects recruited (27 males vs 35 females; 32 controls vs 30 aMCI). Initial reported prevalence of stressors was high with 89% of subjects reporting 1 or more and 71% reporting 2 or more stressors in the previous 6xa0months. Life events causing stress appear sufficiently common within this subject group to warrant further investigation.

Systemic inflammatory responses to stress and its impact on cognition in people with mild cognitive impairment

relation of cerebrovascular perfusion to domains of cognitive performance in non-demented population based samples due in part to feasibility issues and cost of P.E.T. or MRI. Transcranial Doppler (TCD) ultrasound provides an inexpensive, rapid, non-invasive technique for assessing cerebrovascular function. We examined the cross-sectional associations of TCDmeasures of blood flow velocities in arteries of the circle of Willis to cognitive performance in participants in the EAS cohort. Methods: Analyses included 97 non-demented, community residing elderly, age 3 70. TCD was performed by a trained ultrasound technician using a standardized and validated research protocol during the annual clinic visit which included neuropsychological testing and neurological exams. The group was 52% female, mean age 80.9 (65.6) years, mean education 15 years. Cognitive domain evaluation included episodic memory (Free Recall from Free and Cued Selective Reminding Test-FR-FCSRT and WMS-R Logical Memory I subtest -LM), semantic memory (category fluency CF), executive function (WAIS-III digit symbol substitution test-DSST; Trail-Making Test-B TMT-B), and language (phonemic fluency-FAS).We computed the mean of right and left flow velocities (MFV) for each vessel. Spearman’s correlation coefficients were used to examine the relation of MFV in the anterior (ACA_MFV), posterior (PCA_MFV) andmiddle (MCA_MFV) cerebral arteries to cognitive performance. Linear regression analyses were used to determine whether associations persisted after adjustment for age, sex and education. Results: There was a consistent pattern showing a positive correlation between CF, DSST, TMT-B and FAS with ACA_MFVand PCA_MFVwhile memory tests were not correlated with MFV. The MCA-MFV was not correlated with any cognitive measures. The associations of ACA_MFVand PCA_MFV with cognition remained after adjustment for age sex, and education. Conclusions: Cerebral blood flow appears to be more highly correlated with performance on tests of executive function and language than with tests of episodic memory. This is consistent with prior information suggesting a link between vascular processes and frontal executive function. TCD may be useful for distinguishing persons at risk for amnestic versus non-amnestic mild cognitive impairment. Longitudinal data are needed to confirm this hypothesis.

Arbeitsstress, sozialer Stress und Schlafqualitat: Differentielle Effekte unter Berücksichtigung von Alter, Besorgnisneigung und Gesundheit[Work stress, social stress, and sleep quality: differential effects in consideration of age, worry disposition, and health]

Cross-sectional analyses of data from 309 subjects test two hypotheses: (1) Sleep disorders are related to social stress, not work stress, and (2) the personality trait “worry disposition” reveals a direct as well as an indirect, i.e. stress-mediated, effect on sleep disorders. A negative association of sleep quality to social stress, but not work stress is found after controlling for effects of worry, age, and illness frequency. This finding is confirmed by the findings of a subsequent path analysis. A subsequent longitudinal study tests hypothesis (3): Social stress causes impairments in sleep quality. Seventy-six subjects received handheld-computers to measure sleep quality and stress in different domains on two subsequent days. A cross-lagged panel analysis reveals associations of social stress at the first day to sleep quality at the second day, but no reversed relation. Findings point to the relevance of worry disposition and social stress in explaining sleep disorders. An 309 Probanden werden in einer Querschnittsuntersuchung zwei Hypothesen uberpruft: (1) Schlafstorungen hangen mit sozialem Stress zusammen, nicht mit Arbeitsstress und (2) das Personmerkmal Besorgnisneigung hat sowohl einen direkten als auch einen indirekten, uber Stress vermittelten, Effekt auf Schlafstorungen. Nach statistischer Kontrolle der Variablen Besorgnisneigung, Alter und Krankheitshaufigkeit findet sich neben anderen Ergebnissen ein negativer Zusammenhang von Schlafqualitat mit sozialem Stress, nicht aber mit Arbeitsstress. Dieser Befund kann in einer anschliesenden Pfadanalyse bestatigt werden. In einer Langsschnittuntersuchung wird dann Hypothese (3) uberpruft: Sozialer Stress verursacht Beeintrachtigungen der Schlafzufriedenheit. 76 Versuchsteilnehmern wurden Handheld-Computer ausgehandigt, die an zwei aufeinanderfolgenden Tagen Schlafzufriedenheit und verschiedene Arten der Beanspruchung erfassten. Eine crossed-lagged Panel Analyse zeigt einen Zusammenhang von sozialem Stress am ersten Tag mit Schlafzufriedenheit am zweiten Tag, aber keinen umgekehrten Zusammenhang. Die Ergebnisse weisen auf die Bedeutung von Besorgnisneigung und sozialem Stress fur die Erklarung von Schlafstorungen hin.

Geschlechtsunterschiede bei stressbezogenen Variablen: Der Einfluss der Neigung zur Besorgnis [Gender differences in stress-related variables: the influence of worry-disposition]

Zusammenfassung: Obwohl Frauen durchschnittlich von mehr Befindensstorungen, Stress und korperlichen Beschwerden berichten als Manner, weist ihre hohere Lebenserwartung objektiv auf eine bessere Gesundheit hin. Zur Erklarung dieses paradoxen Befundes wird die interindividuell variierende Neigung zur Besorgnis herangezogen. In der Besorgnis-Skala des Trierer Inventar zur Erfassung von chronischem Stress (TICS) zeigt sich eine altersunabhangig starker ausgepragte Besorgnisneigung bei Frauen (N = 1255), die Geschlechtsunterschiede in anderen Skalen zum chronischen Stress aufklart. In einer weiteren Stichprobe (N = 360) erklart die Variable Besorgnisneigung Geschlechtsunterschiede bei stressbezogenen Variablen, die in der Literatur berichtet werden. Nach den hier vorgestellten Ergebnissen lassen sich die durchschnittlich hoheren Werte von Frauen im Stresserleben, bei den fatalistisch-externalen Kontrolluberzeugungen, bei der Stressanfalligkeit, der Depressivitat und bei korperlichen Beschwerden, sowie ihre ge...