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. A long stress response considerably raises the risk of dementia or age-related cognitive decline. Stress drives up the HPA-axis (the brain’s stress system). It raises cortisol and vasopressin. In the end that means wide metabolic changes, behavior changes, and a 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
What raises the risk of dementia?
Dementia is now among the top 5 causes of death in the western world and the US. And as people live longer, they are also prone to cognitive decline that is not dementia. That leads to poorer quality of life and disability.
But not all adults get severe mental decline that causes disability. Genetics cannot explain most cases of severe mental decline. So researchers think it is related to lifestyle. There seem to be many factors behind a greater risk of dementia or faster cognitive decline. Low education and low income are among the leading risk factors.
Western nations are rich compared to many other parts of the world. Yet they have a higher dementia rate. So financial insecurity may appear to be the most unlikely factor behind the condition. But it is key to understand that financial insecurity is a psychological reaction. The financial insecurity people feel may be higher in certain parts of rich societies. Western nations also have a higher cost of living.
Does financial stress raise the risk of stroke and dementia?
Studies show that even minor stress from financial insecurity may raise the risk of neurological disorders (disorders of the brain and nerves). One large nationwide study in Hungary looked at 7880 cases of thrombolytic treatment (clot-busting drugs). They found that the risk of stroke was highest at the end of the month. That was due to greater financial insecurity at that time1.
The National Health and Aging Trends Study in the US found something similar. It looked at data from Medicare beneficiaries older than 65 years of age. It found that financial strain in older adults may raise the risk of dementia by 20% to 30%2.
How does financial stress lead to cognitive decline?
It appears that long-lasting financial insecurity leads to chronic stress. Chronic stress makes certain brain centers (HPA-axis) more active. That makes the pituitary gland trigger more stress hormones. So people living with chronic stress have higher levels of cortisol and vasopressin3.
Studies confirm that people diagnosed with Alzheimer’s or dementia from other causes 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 problems in the long run. That is why chronic stress may raise the risk of dementia.
Cortisol raises blood glucose levels. It raises the risk of insulin resistance (when cells stop answering insulin). It suppresses the immune system and boosts appetite. It also causes a wide range of behavior changes. Together these raise the risk of cognitive decline in older adults5.
Chronic stress also raises levels of vasopressin. This hormone narrows blood vessels and makes the body hold water. Higher levels may raise the risk of hypertension (high blood pressure). It also considerably raises the risk of cardiovascular diseases. This means a greater risk of stroke and cognitive decline5.
But it is key to know that cortisol and vasopressin are important hormones we need to stay healthy. In small amounts, cortisol helps the stress response. So at normal levels it does no harm. A short rise now and then is not always bad either. It is levels that stay high for months or even years that raise the risk of cognitive decline.
Financial insecurity tends to be a long-term problem. For many, it may start at a young age and may last for the rest of their life. Frequent worries and feeling insecure in the end cause metabolic disorders, unhealthy lifestyle choices, and a slow decline in thinking.
To sum up, high stress from financial insecurity is one of the factors that may speed up cognitive decline. This is most true in older adults. It means that managing stress through behavior and lifestyle changes may help lower the risk of cognitive decline and dementia.
Frequently asked questions
Can stress cause dementia?
Chronic stress raises the risk. Stress that lasts months or years keeps the HPA axis switched on. So cortisol and vasopressin stay high. Cortisol raises blood sugar and insulin resistance, suppresses the immune system and boosts appetite. Vasopressin raises blood pressure and cardiovascular risk. People with Alzheimer’s or other dementia have higher cortisol than healthy adults. Short bursts of stress are not the problem.
What are some possible causes of dementia?
Genetics cannot explain most cases of severe mental decline, which points to lifestyle. Low education and low income are among the leading risk factors. Chronic stress, including long-running money worries, adds high cortisol, insulin resistance, high blood pressure and cardiovascular disease. Each of those raises the risk of stroke and cognitive decline. In US adults over 65, financial strain raised dementia risk by 20% to 30%.
Can anxiety cause dementia?
Constant worry works through the same stress pathway. Frequent worries and feeling insecure keep cortisol and vasopressin high. This often goes on for years or starts at a young age. Over time that drives metabolic disorders, unhealthy lifestyle choices and a slow decline in thinking. Managing stress through behavior and lifestyle changes may help lower the risk of cognitive decline and dementia.
Related reading
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
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
