Background: Chronic stress triggers the dysregulation of hypothalamic-pituitary-adrenal (HPA) axis which is characterized by altered diurnal cortisol patterns and increased basal cortisol levels. This dysregulation has been found in Alzheimer's Disease (AD), but its link with AD-related biomarkers remains underexplored. This systematic review aims to synthesize the current knowledge regarding the association between cortisol and biomarkers related to AD.

Methods: Keywords and phrases related to cortisol and AD-related biomarkers were used to search the MEDLINE database via PubMed and OVID interfaces up to January 2024. Studies focused on the association between cortisol levels and genetic, neuroimaging, and fluid biomarkers related to AD. Additionally, sex differences in the associations between cortisol and AD-related markers were explored.

Results: A total of 2465 studies were identified, 54 of which were included in the systematic review. Most included studies were cross-sectional (91%), and measured blood (51.9%) or salivary (44%) cortisol. Only 6.8% of studies had reported on sex differences. Studies assessing the relationship between diurnal cortisol patterns and novel AD-related biomarkers remain scarce. Elevated cortisol levels tended to be associated with AD-related biomarkers, although associations were dependent on the cortisol measurement strategy and study populations.

Conclusion: Findings have been mixed, partly due to differences in cortisol measurement methodologies, including the timing and source of cortisol assessment. More longitudinal studies are needed to determine whether cortisol dysregulation preceded pathological changes related to AD.

To address the challenge of labor market shortages, and workforce aging, this cross-sectional study explore the individual, work, and family factors associated with early (age <= 64) or late (age >= 66) expected retirement timing (ERT) among older long-term care (LTC) workers in Sweden. Data were drawn from the Swedish Longitudinal Occupational Survey of Health in 2018, comprising a sample of men and women aged 50-64 (n=550), working in LTC for older people. The results suggest that higher job demands and higher job satisfaction increase the likelihood of older LTC workers' early ERT. Shorter tenure and factors in work that enhance family life were associated with increased likelihood for late ERT.

BACKGROUND: Behavioral and Psychological Symptoms of Dementia (BPSD) affect up to 90% of people living with dementia and present significant challenges for individuals, relatives, and care staff, often impacting quality of life and care provision. Despite the high prevalence and fluctuating nature, BPSD are often monitored infrequently in routine care, limiting opportunities for timely, person-centered interventions. Digital tools that support frequent and individualized symptom monitoring may help bridge this gap.

METHODS: This study explored contextual factors, including barriers, facilitators, needs, and expectations, relevant to the potential implementation of Daily-BPSD, a digital tool designed to support individualized and frequent monitoring of BPSD in Swedish nursing homes. This participatory design study was conducted in two stages. Preparatory semi-structured interviews with disability care staff guided the initial design of the Daily-BPSD prototype, followed by research circles with nursing home staff and relatives. Data were analyzed thematically.

RESULTS: The analysis generated six themes: (1) implementation and adoption, (2) usability and accessibility, (3) communication and collaboration, (4) value for care and people with dementia, (5) training and support, and (6) the selection and interpretation of relevant variables to monitor. The findings were interpreted in relation to established determinants of technology acceptance, providing a structured understanding of factors shaping the anticipated adoption of Daily-BPSD.

CONCLUSION: Findings emphasize the need to align digital tools with everyday work routines, ensure adequate training, and address infrastructural conditions for reliable use. By outlining conditions that may enable or hinder daily monitoring of BPSD, this study contributes to the development phase of complex intervention design. It provides a foundation for further refinement and feasibility testing of Daily-BPSD in dementia care.

Introduction: Short and long sleep duration as well as poor sleep quality have been linked to higher prevalence of metabolic disorders. However, it is still unclear how diverse sleep variables relate to different metabolic pathways. This study examines how different features of sleep health relate to serum metabolites.

Materials and methods: The study used data from 197 healthy individuals aged 20-79 (Females n=103) from the IronAge study performed at Karolinska Institutet in Sweden. Sleep variables were assessed with the Karolinska Sleep Questionnaire, where the following variables were computed: sleep duration, sleep debt, midpoint, social jetlag (i.e., the discrepancy between midpoint on free and workdays), napping frequency and sleep quality. Morning fasting blood samples were collected and 1H NMR spectroscopy was utilized for metabolomic analysis. The metabolites were categorized according to their major metabolic pathways: amino acid, lipid, carbohydrate, energy and gut microbiota. Linear regressions were performed to examine the relationship between each sleep variable and metabolite.

Results: Sleep duration, midpoint of sleep on free days, social jetlag and chronotype associated with eight metabolites at a significance level of p<0.01. Notably, midpoint associated with most metabolites spanning multiple pathways. A later midpoint was associated with higher levels of metabolites in the lipid pathway, and lower levels in the amino acid and energy pathway.

Conclusions: These observations indicate that sleep timing features, midpoint and social jetlag, have a stronger relationship with morning metabolism than other sleep health dimensions. Following replication in larger samples, these complex relationships may hold potential for health promotion.

OBJECTIVE: Test the hypothesis that depressive symptoms are associated with cognitive performance and that cortisol levels may explain this association independently of Alzheimer's Disease (AD) biomarker levels.

DESIGN: Longitudinal observational study.

SETTING: Memory clinic, Karolinska University Hospital, Stockholm, Sweden.

PARTICIPANTS: Consecutive patients (n = 162) who agreed to take part in the Cortisol and Stress in AD (Co-STAR) study during 2014-2017 and had data available for variables of interest.

MEASUREMENTS: Participants rated their depressive symptoms using the Geriatric Depression Scale (GDS) and collected diurnal salivary cortisol samples at home. Cognitive performance was assessed by standardized cognitive tests in the following domains: memory, working memory, processing speed, perceptual reasoning, and general cognitive function. Dementia, mild cognitive impairment (MCI), and subjective cognitive decline (SCD) were diagnosed as part of the clinical work-up. We determined the associations between GDS and cognitive domain scores using linear regressions, including cortisol levels as covariates. We also tested if cerebrospinal fluid (CSF) AD biomarkers amyloid β42 (Aβ42) and tau proteins modified these associations.

RESULTS: The GDS score was negatively associated with performance in working memory and processing speed, independently of cortisol levels. These associations were no longer significant after introducing AD biomarkers as covariates. Baseline GDS score was not associated with change in memory or processing speed at follow-up.

CONCLUSIONS: The underlying amyloid pathology may affect the association between depressive symptoms and cognitive performance in memory clinic patients.

The study investigated the relationship between how child welfare social workers (n = 309) assessed their first-line managers' leadership and how they perceived their working conditions. A cross-sectional survey, based on the QPS Nordic questionnaire, was conducted in Stockholm County, Sweden. The analyses focused on the extent to which social workers assessed the leadership of their first-line managers to be empowering, supportive, and fair, and how they perceived quantitative demands, learning demands, control of decisions, role clarity, and role conflicts at work. Supportive leadership was most clearly related to working conditions and was significantly associated with how all working conditions were perceived. The more supportive the social workers assessed the leadership to be, the lower they perceived quantitative demands, learning demands, and role conflicts, along with more control of decisions and role clarity. There were less frequent associations between how working conditions were perceived and how fair leadership and empowering leadership, respectively, were assessed. The importance of leadership is underlined, especially in regard to supporting the social workers when needed. The findings show the importance of child welfare organizations ensuring that managers can provide consistent support and guidance in relation to problems and dilemmas the social workers might encounter. This article investigates the relationship between how 309 child welfare social workers assess their first-line managers' leadership and how they perceive their working conditions. A questionnaire was distributed to child welfare social workers in Stockholm County, Sweden. The results show that support from the manager was the most important for how the social workers perceive their working conditions. The more support the social workers received, the better they perceived their working conditions to be. There was a clear relationship between perceiving one's manager as fair and perceiving lower demands in terms of time pressure and the amount of work one was expected to complete. In contrast, experiencing leadership as empowering was less important for how the social workers perceived their working conditions. The takeaway message for social work practice is that leadership is important, especially that social workers receive help and support when needed.

PURPOSE OF THE RESEARCH: Stress has a clear impact on health and function. Yet, little is known about how different stressors (factors that cause stress) in various contexts throughout the life course impact cognitive and physical aging. The study aimed to investigate if different types of stressors predicted cognitive and physical impairment in late life. The role of social support and internal locus of control was also investigated.

MATERIAL AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over 21 years, including retrospective childhood data (n = 1086). Indicators of work and financial stressors were assessed at late midlife (M=62 years) and financial stressors at early late life (M=70). Social support and internal locus of control were assessed at the mean ages of 62 and 70 years. Physical and cognitive impairment were assessed at late life (M=83). Path analyses were conducted with maximum likelihood estimation and adjusted for smoking, age, sex, educational attainment, and follow-up period.

RESULTS: Work stressors were associated with physical and cognitive impairment directly. Work stressors were also associated with financial stressors, which, in turn, were associated with physical impairment. Childhood conflicts were associated with less social support, and less social support was associated with worse cognitive aging. Internal locus of control was not associated with cognitive and physical impairment.

CONCLUSIONS: This study confirms that stressors earlier in life predict cognitive and physical aging, but that different types of stressors have different paths to impact impairment in late life.

BACKGROUND: Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. The goal of this study was to investigate whether financial stress is associated with cognitive and physical impairment and their combination, the role of potential modifiable factors and potential sex differences.

METHODS: The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n = 1497) (baseline data collected 1972-1987, mean age 50 years). Two late-life re-examinations (mean total follow-up 21 years). Midlife financial stress was measured using two questions on financial situation. Cognitive functioning was based on six cognitive domains. Physical impairment was self-reported, including activities of daily living and mobility. Potential mediation factors investigated were smoking, alcohol, physical activity, cohabitant status, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation.

RESULTS: Midlife financial stress was associated with worse cognitive functioning, physical impairment and their combination. Smoking and sleep disturbances mediated the associations between financial stress, physical impairment, and combined impairments. For men: Among smokers financial stress was associated with worse cognitive functioning; alcohol interacted with financial stress on combined impairments; cohabitation and non-manual work mediated associations to worse cognitive functioning. Among women, sleep disturbances moderated the association to worse cognitive functioning.

CONCLUSIONS: Midlife financial stress is associated with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.

The COVID-19 pandemic placed significant psychological strain on healthcare workers. Our study tracked health care workers in the Czech Republic throughout the pandemic to examine the impact of stressors on psychological distress over time and explore gender differences in these associations. We studied health care workers from the Czech arm of the international COVID-19 HEROES Study who took part in all three waves of data collection in 2020, 2021 and 2022 (n = 264). We employed a path model to examine the relationships among six stressors (low trust in workplace, assignment of new tasks, prioritization of patients, experience of death due to COVID-19, experience of discrimination or violence, contact with COVID-19 patients), psychological distress (measured by General Health Questionnaire), and covariates (age, gender, occupation). We incorporated autoregressive paths and interactions to assess the longitudinal impact of stressors. Prior levels of distress predicted subsequent distress, with significant carry-over effects observed between each wave. Stressors had direct association to distress in the same wave of data collection (2020 and 2021), but not in subsequent waves, and stressors in 2022 did not have a significant direct effect to distress. Men reported lower distress in 2020 and 2021, but not in 2022. Furthermore, no significant interactions between stressors and gender were found. Age and occupation were not related to distress levels. There is a need for adaptable mental health support that addresses current stressors through targeted interventions, while also providing ongoing monitoring beyond crises, particularly for individuals with high distress levels.

Study objectives: Short and long sleep duration as well as poor sleep quality have been linked to higher prevalence of metabolic disorders. However, it is still unclear how diverse sleep variables relate to different metabolic pathways. This study examines how different features of sleep health relate to serum metabolites.

Methods: The study used data from 197 healthy individuals aged 20–79 (Females n = 103) from the IronAge study performed at Karolinska Institutet in Sweden. Sleep variables were assessed with the Karolinska Sleep Questionnaire, where the following variables were computed: sleep duration, sleep debt, midpoint, social jetlag (i.e., the discrepancy between midpoint on free and workdays), napping frequency and sleep quality. Morning fasting blood samples were collected and ¹H NMR spectroscopy was utilized for metabolomic analysis. The metabolites were categorized according to their major metabolic pathways: amino acid, lipid, carbohydrate, energy and gut microbiota. Linear regressions were performed to examine the relationship between each sleep variable and metabolite.

Results: Sleep duration, midpoint of sleep on free days, social jetlag and chronotype associated with eight metabolites at a significance level of p<0.01. Notably, midpoint associated with most metabolites spanning multiple pathways. A later midpoint was associated with higher levels of metabolites in the lipid pathway, and lower levels in the amino acid and energy pathway.

Conclusion: These observations indicate that sleep timing features, midpoint and social jetlag, have a stronger relationship with morning metabolism than other sleep health dimensions. Following replication in larger samples, these complex relationships may hold potential for health promotion.