Summary: The risk of dementia is higher in people with low socioeconomic status. Low income or financial insecurity is one of the major sources of chronic stress. Prolonged stress response considerably increases the risk of dementia or age-related cognitive decline. Stress results in higher activity of the HPA-axis elevated cortisol and vasopressin. It ultimately means broader metabolic changes, behavioral changes, greater risk of cardiovascular events. All this also leads to a considerably greater risk of dementia.
Keywords: financial insecurity, dementia, cognitive decline, stress, chronic stress, cortisol, vasopressin
Introduction
Dementia is now among the top 5 causes of mortality in the western world and the US. Moreover, as people live longer, they are also prone to non-dementia cognitive decline, resulting in poorer quality of life and disability.
However, severe mental decline causing disability is not seen in all adults. Since genetics cannot explain the cases of severe mental decline in most cases, researchers think it is related to lifestyle. There seem to be numerous factors for the greater risk of dementia or faster cognitive decline. Low education and incomes are among the leading risk factors.
Although, western nations are prosperous compared to many other parts of the world, but they have a higher dementia rate. Thus, financial insecurity may appear as the most unlikely factor contributing to the condition. However, it is essential to understand that financial insecurity is a psychological reaction. The perceived financial insecurity may be higher in certain sections of prosperous societies. Further, western nations also have a higher cost of living.
Perceived financial insecurity increases the risk of neurological disorders
Studies show that even minor stress caused by financial insecurity may increase the risk of neurological disorders. For example, in one of the large-scale nationwide studies in Hungary, researchers analyzed 7880 cases of thrombolytic treatment. They found that the risk of stroke was highest at the end of the month due to greater financial insecurity at that time1.
Similarly, The National Health and Aging Trends Study in the US, which analyzed the data of Medicare beneficiaries older than 65 years of age, found that financial strains in older adults may increase the risk of dementia by 20% to 30%2.
What could be the link between the greater risk of cognitive decline and financial insecurity?
It appears that prolonged financial insecurity leads to chronic stress. Chronic stress results in greater activity of certain brain centers (HPA-axis), causing the pituitary gland to stimulate the production of stress hormones. Thus, those living with chronic stress have higher levels of cortisol and vasopressin3.
Studies confirm that those diagnosed with Alzheimer’s or other-causes-dementia have higher cortisol than healthy adults4.
Cortisol is a complex hormone. It may not cause any side effects in the short run. But it may cause major metabolic issues in the long run. That is why chronic stress may increase the risk of dementia.
Cortisol increases blood glucose levels, increases the risk of insulin resistance, suppresses the immune system, boosts appetite, and causes a wide range of behavioral changes. Which ultimately increases the risk of cognitive decline in older adults5.
Further, chronic stress also increases levels of vasopressin, a hormone that causes vasoconstriction and water retention. Its higher levels may increase the risk of hypertension. In addition, it considerably increases the risk of cardiovascular diseases. Thus, a greater risk of stroke and cognitive decline5.
However, it is essential to know that cortisol and vasopressin are important hormones needed to stay healthy. In small amounts, cortisol helps improve stress response. Thus, it does not cause harm in its normal levels. Intermittent increase in its levels is also not essentially bad. However, its continuous elevated levels for months or even years is what increases the risk of cognitive decline.
Financial insecurity tends to be a long-term issue. For many, financial insecurity may start from a young age and may last for the rest of the life. Frequent worries and feeling insecure ultimately cause metabolic disorders, unhealthy lifestyle choices, and a slow decline in cognition.
To conclude, high stress caused by financial insecurity, especially in older adults, is one of the factors that may accelerate cognitive decline. It means that managing stress through behavioral changes, lifestyle interventions may help lower the risk of cognitive decline and dementia.
References
1. Folyovich A, Biczó D, Bajnok A, et al. Higher Incidence of Stroke on the Last Day of the Month in Hungary—a Role for Psychosocial Factors and Financial Insecurity? Journal of Stroke and Cerebrovascular Diseases. 2016;25(5):1192-1195. doi:10.1016/j.jstrokecerebrovasdis.2016.02.010
2. Samuel LJ, Szanton SL, Wolff JL, Ornstein KA, Parker LJ, Gitlin LN. Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of US older adults: an examination of financial resources. BMC Geriatrics. 2020;20(1):156. doi:10.1186/s12877-020-01553-4
3. Magri F, Cravello L, Barili L, et al. stress and dementia: the role of the hypothalamic-pituitary-adrenal axis. Aging Clin Exp Res. 2006;18(2):167-170. doi:10.1007/BF03327435
4. Ouanes S, Popp J. High Cortisol and the Risk of Dementia and Alzheimer’s Disease: A Review of the Literature. Frontiers in Aging Neuroscience. 2019;11:43. doi:10.3389/fnagi.2019.00043
5. Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB Rep. 2015;48(4):209-216. doi:10.5483/BMBRep.2015.48.4.275
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