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Abstract
In this narrative review, we examine biological processes linking psychological stress
and cognition, with a focus on how psychological stress can activate multiple neurobiological
mechanisms that drive cognitive decline and behavioral change. First, we describe
the general neurobiology of the stress response to define neurocognitive stress reactivity.
Second, we review aspects of epigenetic regulation, synaptic transmission, sex hormones,
photoperiodic plasticity, and psychoneuroimmunological processes that can contribute
to cognitive decline and neuropsychiatric conditions. Third, we explain mechanistic
processes linking the stress response and neuropathology. Fourth, we discuss molecular
nuances such as an interplay between kinases and proteins, as well as differential
role of sex hormones, that can increase vulnerability to cognitive and emotional dysregulation
following stress. Finally, we explicate several testable hypotheses for stress, neurocognitive,
and neuropsychiatric research. Together, this work highlights how stress processes
alter neurophysiology on multiple levels to increase individuals’ risk for neurocognitive
and psychiatric disorders, and points toward novel therapeutic targets for mitigating
these effects. The resulting models can thus advance dementia and mental health research,
and translational neuroscience, with an eye toward clinical application in cognitive
and behavioral neurology, and psychiatry.
Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.
Summary Background The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019. Methods In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019. Findings Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America. Interpretation GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative. Funding Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.
Here we report that increased pup licking and grooming (LG) and arched-back nursing (ABN) by rat mothers altered the offspring epigenome at a glucocorticoid receptor (GR) gene promoter in the hippocampus. Offspring of mothers that showed high levels of LG and ABN were found to have differences in DNA methylation, as compared to offspring of 'low-LG-ABN' mothers. These differences emerged over the first week of life, were reversed with cross-fostering, persisted into adulthood and were associated with altered histone acetylation and transcription factor (NGFI-A) binding to the GR promoter. Central infusion of a histone deacetylase inhibitor removed the group differences in histone acetylation, DNA methylation, NGFI-A binding, GR expression and hypothalamic-pituitary-adrenal (HPA) responses to stress, suggesting a causal relation among epigenomic state, GR expression and the maternal effect on stress responses in the offspring. Thus we show that an epigenomic state of a gene can be established through behavioral programming, and it is potentially reversible.
[1
]Centre for Addiction and Mental Health, (
https://ror.org/03e71c577)
1001 Queen Street West, Toronto, ON M6J1H4 Canada
[2
]Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, (
https://ror.org/03dbr7087)
Toronto, ON Canada
[3
]Sunnybrook Health Sciences Centre, Division of Neurology, (
https://ror.org/03wefcv03)
Toronto, ON Canada
[4
]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Temerty Faculty of Medicine, , Toronto Dementia Research Alliance, University of Toronto, ; Toronto, ON Canada
[5
]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Department of Psychiatry and Biobehavioral Sciences, , University of California, Los Angeles, ; Los Angeles, CA USA
[6
]Counselling Psychology, Faculty of Education, University of Ottawa, (
https://ror.org/03c4mmv16)
Ottawa, ON Canada
[7
]School of Psychology, Faculty of Social Sciences, University of Ottawa, (
https://ror.org/03c4mmv16)
Ottawa, ON Canada
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History
Date
received
: 13
June
2023
Date
accepted
: 24
October
2023
Funding
Funded by: Temerty-Tanz-TDRA Initiative on Dementia and Depression
Funded by: California Governor’s Office of Planning and Research/California Initiative to Advance
Precision Medicine
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