Lower Cortisol Awakening Response Research Articles

The cortisol awakening response is blunted in healthy women early postpartum

IntroductionThe dynamic capacity of the hypothalamic-pituitary-adrenal (HPA) axis supports healthy adaptions to stress and play a key role in maintaining mental health. Perinatal adaptations in the HPA-axis dynamics in terms of the Cortisol Awakening Response (CAR), may be involved in dysregulation of perinatal mental health. We aimed to determine if CAR and absolute evening cortisol early postpartum differed from non-perinatal women and evaluate the association between the CAR and maternal mental well-being. MethodsThe CAR was computed as the area under the curve with respect to increase from baseline from serial home-sampling of saliva across 0–60 minutes from awakening. We evaluated differences in CAR and absolute evening cortisol between postpartum women (N=50, mean postpartum days: 38, SD: ±11) and non-perinatal women (N=91) in a multiple linear regression model. We also evaluated the association between CAR and maternal mental well-being in a multiple linear regression model. ResultsWe found that healthy postpartum women had a blunted CAR (p<0.001) corresponding to 84% reduction and 80% lower absolute evening cortisol (p<0.001) relative to non-perinatal healthy women. In the postpartum group, there was a trend-level association between lower CAR and higher scores on the WHO Well-Being Index (WHO-5) (p=0.048) and lower Edinburgh Postnatal Depression Scale (EPDS) scores (p=0.04). ConclusionOur data emphasize the unique hormonal landscape during the postpartum period in terms of blunted CAR and lower absolute evening cortisol in healthy women early postpartum compared to non-perinatal. Our findings show a potential association between a reduced CAR and improved mental well-being during early motherhood, which suggests that reduced CAR might reflect healthy adjustment to early motherhood.

Disentangling the effects of depression and perceived stress on cortisol levels in individuals with obesity: Preliminary results from a cross-sectional study

BackgroundHypothalamic-pituitary-adrenal (HPA) axis dysregulation has been suggested to play a role in the association between depression and obesity. The study aimed to investigate differences in cortisol levels in individuals with obesity with and without depression and the role of perceived stress on these differences. MethodsSaliva samples were collected at awakening, 15-, 30- and 60-minutes post-awakening from 66 individuals with obesity (30 with major depressive disorder and 36 without major depressive disorder). Salivary cortisol was analysed using ELISA technique. Linear Mixed Models were used for group differences in cortisol awakening response (CAR) with adjustment for socio-demographic confounders and binge eating. ResultsIndividuals with obesity and depression had lower CAR compared with individuals with obesity without depression (β = −0.44; p = 0.036). When controlling for perceived stress, CAR was no longer influenced by depression (β = −0.09; p = 0.75), but individuals with moderate/high stress had lower CAR compared with those with low stress (β = −0.63; p = 0.036). ConclusionsOur results suggest that differences in CAR between individuals with obesity with and without depression could be due to higher levels of perceived stress in the depressed subjects.

Context and Neuroendocrine Interplay in the Lab and Everyday Experiences: From Early Life to Adulthood

Context and Neuroendocrine Interplay in the Lab and Everyday Experiences: From Early Life to Adulthood

Sleep and Diurnal Cortisol Patterns: Cultural Prediction and Moderation Among Latino College Students

Sleep is a bioregulatory mechanism that promotes healthy physiological stress processes. Little research has examined daily links between sleep and diurnal cortisol patterns in minoritized youth populations, or explored whether such links are predicted by developmentallysalient cultural factors. Using a strengths-based approach to understanding cultural neurobiology, we examined individual (e.g., familism values) and institutional (i.e., changes in co-ethnic concentration) predictors of diurnal cortisol patterns, and whether cultural factors moderated daily links between sleep and cortisol. Methods: Salivary cortisol was collected five times a day in conjunction with actigraphy sleep across three weekdays in a sample of 180 Latino first-year college students (Mage=18.95; 64.4% female). High school and college institutional characteristics and self-reported cultural values were also collected. Results: Three-level growth curve analyses revealed greater sleep duration one night was linked with higher waking cortisol (γ=.119, p<.01), lower cortisol awakening responses (CAR; γ=-.070, p=.01), and steeper cortisol slopes (DCS; γ=-.035, p<.01) the next day. Experiencing more congruent campus contexts, but not familism, was associated with greater CAR (γ=.251, p<.05), on average. Familism values moderated day-to-day associations; greater sleep duration one night was associated with steeper DCS the next day for individuals reporting low (b=-.053, p=.003) or average levels of familism (b=-.036, p=.001). Conclusion: Findings illustrate cultural neurobiological processes as longer sleep was linked with healthier diurnal profiles in Latino college students and individual cultural values and exposure to coethnic peers served as protective and promotive factors, respectively.

Additive, Common, and Cumulative Contributions of Stress on Diurnal Cortisol Activity: Evidence Among Latino College Students

The transition to college is a major socio-contextual shift marked by opportunity and stress. Adolescents who encounter significant stress during this time may experience changes in neuroendocrine function, an identified mechanism underlying associations between stress and psychopathology. Latino students may be particularly at-risk for stress exposure, as ethnic/racial minority youth experience both minority-specific and general life stressors. This study employed a “multi-risk model” to examine additive, common, and cumulative effects of various stressors on Latino college students’ diurnal cortisol. 180 Latino college students (Mage=18.95; 64.4% female) provided five saliva samples a day across three weekdays (M=14.88, SD=.95; 2,667 samples) to assess diurnal cortisol patterns (i.e., cortisol awakening response (CAR), diurnal cortisol slope (DCS)). Participants self-reported on multiple stress forms (general, academic, social, financial, bicultural, discrimination) via online survey and daily diary. Common and cumulative stress were assessed via exploratory factor analysis and cumulative risk index, respectively. Three-level growth curve models were fit using Mplus. In the additive model, general stress was associated with a flatter DCS (γ=.01, p=.03) and bicultural stress was linked with a steeper DCS (γ=-.07, p=.047). In the common model, college stress was related to a lower CAR (γ=-.09, p=.045). Higher cumulative stress was linked with a lower CAR (γ=-.06, p=.007). Findings highlight the physiological correlates of various stressors experienced by Latino college students. Results have implications for equity promoting interventions to reduce stress and subsequent physiological processes underlying the development of psychopathology.

Pregnancy-specific anxiety and gestational length: The mediating role of diurnal cortisol indices

BackgroundPreterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length. MethodsA sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS. ResultsThere was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= −0.102(0.057), .95CI [− 0.227,− 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= −0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length. ConclusionLower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.

Stress and diurnal cortisol among Latino/a college students: A multi-risk model approach.

The transition to college is a time of increased opportunity and stress spanning multiple domains. Adolescents who encounter significant stress during this transition may be vulnerable to adverse outcomes due to a "wear and tear" of the hypothalamic pituitary adrenal (HPA) axis. Latino/a students may be particularly at-risk for heightened stress exposure due to experiences of both minority-specific and general life stress. Despite this, little is known regarding the cumulative impact of multiple stressors on Latino/a students' HPA axis functioning. The present study employed a "multi-risk model" approach to examine additive, common, and cumulative effects of multiple stress forms (general, academic, social, financial, bicultural, ethnic/racial discrimination) on diurnal cortisol in a sample of first-year Latino/a college students (N = 196; 64.4% female; Mage = 18.95). Results indicated that no stress forms were additively associated with the cortisol awakening response (CAR), but general stress was associated with a flatter diurnal cortisol slope (DCS) and bicultural stress was linked with a steeper DCS. A college stress latent factor was associated with a lower CAR, whereas a latent factor of discrimination was not associated with diurnal cortisol. Cumulative risk was linked with a lower CAR. Findings highlight the physiological correlates of various stressors experienced by Latino/a college students.

Acute Exercise-induced Changes In The Cortisol Awakening Response

The effects of acute exercise on the cortisol awakening response (CAR), characterized by the rapid increase in cortisol concentrations within the 30 - 45 minutes following sleep offset, have yet to be fully elucidated. PURPOSE: Thus, this study investigated the effects of late-evening acute exercise on the CAR the following morning. We hypothesized an altered cortisol concentration and dynamic during the post-awakening period, driven by the effect of prior evening exercise. METHODS: Twelve participants (mean (SD): age = 23 (4) y; mass = 76.8 (8.7) kg; height = 175.6 (5.0) cm; VO2max = 48.9 (7.5) ml.kg-1.min-1) reported to the laboratory in the evening (1800 h) on two occasions and completed, in random order, an exercise (70-75% of maximal power output) and rest condition. During the one-hour post-awakening period, blood and saliva samples were collected every 15 min and assayed later for cortisol via enzyme-linked immunoassay. Mixed-effects growth models determined the effect of exercise on the cortisol response post-waking in both blood and saliva. RESULTS: Expectedly, cortisol concentrations in both blood (βLinear = 234.89, [95%CI; 119.28, 350.50], p < 0.001; βQuadratic = -245.42, [-356.28, -134.56], p < 0.001, Conditional R2 = 0.705) and saliva (βLinear = 52.25, [29.93, 74.56], p < 0.001; βQuadratic = -42.04, [-63.44, -20.65], p < 0.001, Conditional R2 = 0.576) significantly increased, in a quadratic manner, during the post-awakening period. Additionally, the cortisol responses during the post awakening period were significantly lower following the exercise condition than the rest condition (serum, βCondition = -42.26 [-64.52, -20.01], p < 0.001; saliva, βCondition = -11.55 [-15.52, -7.57], p < 0.001). CONCLUSIONS: In support of our hypothesis, these results suggest that cortisol concentrations in both saliva and blood are significantly lower the morning following a prior evening exercise session. Lower CAR may result from increased cellular uptake of cortisol or a physiological decrease in adrenal output to conserve resources for the next day. We demonstrated that the CAR is sensitive to acute exercise bouts, and thus the CAR may serve as a useful biomarker to monitor responses to exercise training.

Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men

Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men’s lived experiences that should be explored in future research.

Prior night sleep moderates the daily spillover between conflict with peers and family and diurnal cortisol.

We investigated whether daily experiences of conflict with family and peers were associated with fluctuations in diurnal cortisol, and whether sleep buffers the associations between conflict and diurnal cortisol. A racially diverse sample of 370 adolescents (ages 11-18; 57.3% female) provided daily diaries for 5 days and saliva samples for 4 days. Hierarchical linear models tested how peer and family conflict were associated with diurnal cortisol (i.e., total cortisol output, cortisol slope, and cortisol awakening response) the next day, and whether these associations were moderated by sleep duration the previous night. When adolescents experienced peer conflict, they showed higher area under the curve (AUC) the next day if they had slept less the night prior to conflict, but relatively lower cortisol awakening response (CAR) and flatter cortisol slope the next day if they had slept more the night prior to conflict. When adolescents experienced family conflict, they also showed higher AUC the next day if they had slept less the night prior to conflict, but higher CAR the next day if they had slept more the night prior to conflict. Family conflict and sleep were not directly or interactively related to cortisol slope.

The Impact of Mindfulness Training on Police Officer Stress, Mental Health, and Salivary Cortisol Levels

Unaddressed occupational stress and trauma contribute to elevated rates of mental illness and suicide in policing, and to violent and aggressive behavior that disproportionately impacts communities of color. Emerging evidence suggests mindfulness training with police may reduce stress and aggression and improve mental health, but there is limited evidence for changes in biological outcomes or the lasting benefits of mindfulness training. We conducted a randomized controlled trial (RCT) of 114 police officers from three Midwestern U.S. law enforcement agencies. We assessed stress-related physical and mental health symptoms, blood-based inflammatory markers, and hair and salivary cortisol. Participants were then randomized to an 8-week mindfulness intervention or waitlist control (WLC), and the same assessments were repeated post-intervention and at 3-month follow-up. Relative to waitlist control, the mindfulness group had greater improvements in psychological distress, mental health symptoms, and sleep quality post-training, gains that were maintained at 3-month follow-up. Intervention participants also had a significantly lower cortisol awakening response (CAR) at 3-month follow-up relative to waitlist control. Contrary to hypotheses, there were no intervention effects on hair cortisol, diurnal cortisol slope, or inflammatory markers. In summary, an 8-week mindfulness intervention for police officers led to self-reported improvements in distress, mental health, and sleep, and a lower CAR. These benefits persisted (or emerged) at 3-month follow-up, suggesting that this training may buffer against the long-term consequences of chronic stress. Future research should assess the persistence of these benefits over a longer period while expanding the scope of outcomes to consider the broader community of mindfulness training for police.Clinical Trial Registration: ClinicalTrials.gov#NCT03488875.

Long-term cortisol levels in hair of children and adolescents with Prader-Willi Syndrome

ContextPrader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction. In children with PWS, stress-induced central adrenal insufficiency (CAI) has been described, however, daily life cortisol production may be normal. Hair cortisol concentration (HCC) is a marker of long-term systemic cortisol production. Cortisol awakening response (CAR) is the increase in cortisol level after awakening. A negative CAR might suggest hypothalamic-pituitary-adrenal (HPA)-axis reactivity problems. Little is known about HCC and CAR in children with PWS. ObjectiveTo investigate long-term cortisol levels in hair and CAR in children with PWS. DesignCross-sectional study. Patients41 children with PWS. SettingDutch PWS Reference Center. Main outcome measuresHCC and salivary cortisol measured by LCMS. ResultsMedian (IQR) HCC was 1.90 (1.02–3.30) pg/mg at a median (IQR) age of 14.5 (8.20–19.0) years, with median HCC in age-matched references being 2.63 pg/mg. Five patients (13.2%) had HCC < 2.5th percentile for age and these patients had a repeatedly negative CAR. Median HCC was significantly lower in patients with negative CAR than in patients with normal CAR (1.00 (0.22–1.59) vs. 2.25 (1.47–3.26) pg/mg, p = 0.007). One patient had both HCC < 2.5th percentile and repeatedly low morning salivary cortisol levels and negative CAR, and was diagnosed with adrenal insufficiency by overnight metyrapone test. ConclusionsHCC were normal in the majority of children with PWS. Our data suggest that children with HCC < 2.5th percentile and (repeatedly) negative CAR might possibly have adrenal insufficiency or delayed HPA-axis responsiveness.

The Absence of Cortisol Awakening Response Is Associated With Personality Traits in Bariatric Women

Abstract Background: There is a large body of evidence linking obesity to the HPA axis and cortisol secretion or metabolism. Early work hypothesized that obesity onset may be associated with over-activation of the HPA axis, causing an extenuation of the system. The cortisol awakening response (CAR) has been suggested to be a reliable marker of HPA axis activity and has already been examined in samples of individuals with obesity. Our objective was to compare individuals showing a morning cortisol peak (CAR responders) from those who did not (non-responders) and identify possible metabolic or psychological differences among these two groups. Our hypothesis was that the two groups differed in the level of anxiety and aspects of their personality rather than in their metabolic profile. Methods: CAR response was determined using a baseline to peak cut-off of 2.5 nM. Nine CAR non-responder women awaiting bariatric surgery (BMI: 50.8 ± 4.6 kg/m2) were compared to 9 sex- and age-matched CAR responders (BMI: 48.1 ± 5.9 kg/m2). Participants collected salivary cortisol upon awakening as well as 15, 30 minutes after and responded to psychological questionnaires that measured anxiety (State and trait anxiety inventory questionnaire) and personality traits (Temperament and character inventory). Results: Non-responders were all non-diabetic women aged 37 ± 8 years. There was no significant difference between CAR responders and non-responders in terms of BMI or waist circumference. No difference was found in metabolic variables such as glycaemia or the lipid profile. As expected, non-responders had a significantly lower CAR AUCi when compared to responders (p&amp;lt;0.001). However there was no difference in awakening cortisol concentration. Despite our hypothesis, no significant difference was found in general level of anxiety between the two groups. Finally, we analyzed aspects of human personality. We found that CAR responders scored significantly higher in character traits such as self-directedness (p=0.02), cooperativeness (p=0.03) and self-transcendence (p&amp;lt;0.01). Conclusion: The CAR differences in women with severe obesity are not associated with adiposity. Our data show that non-responders exhibit traits related to reduced self-determination and responsibility but also lower level of self-consciousness and helpfulness, which could be associated with a reduction in patient compliance and possibly less weight loss after surgery.

Curvilinear associations between family income in early childhood and the cortisol awakening response in adolescence

Previous evidence on cortisol output and socioeconomic status (SES) has been mixed, with studies finding that lower SES can be associated with higher or lower cortisol output, and null associations have also been reported. We hypothesized that these inconsistencies may be due to an underlying curvilinear, inverted-U pattern of association, such that low income is related to increased likelihood of both low and high cortisol output. We tested these curvilinear links among family income and cortisol indices in the Avon Longitudinal Study of Parents and Children (N = 803). Maternal reports of family income when the study children were 33 and 47 months of age were averaged to estimate early-childhood family income. Three cortisol indices were derived from samples collected in adolescence (15.5 years of age): the cortisol awakening response (CAR), area under the curve (AUC) cortisol, and the diurnal cortisol slope. As hypothesized, the CAR exhibited a curvilinear, inverted-U relation with childhood income, with low childhood income being associated with both the lowest and the highest CARs. These findings suggest that discrepancies in prior findings on low SES and the CAR may be due to curvilinear patterns of association. However, childhood income was not significantly associated with adolescent cortisol diurnal slope or AUC. Future work should clarify the factors that might predispose to high versus low CAR given equivalent low SES in childhood.

Community violence exposure and cortisol awakening responses in adolescents who are overweight/obese

BackgroundCommunity violence exposure has been identified as a salient environmental stressor associated with dysregulated cortisol awakening response (CAR), which may act to exacerbate hypothalamic−pituitary−adrenal (HPA) axis dysregulation observed in adolescents who are overweight/obese. PurposeTo perform an exploratory cross-sectional analysis examining the association between community violence exposure and CAR in adolescents who are overweight/obese. MethodsOne-hundred adolescents (ages: 13–19 years; 65% female; average BMI percentile: 93.80 ± 4.13) were included in this analysis. Community violence exposure was measured using the Survey of Children’s Exposure to Community Violence. Salivary cortisol collected across three days at awakening and 30 min post-awakening was used to calculate CAR area under the curve (AUC). ResultsCommunity violence exposure was associated with a lower CAR AUC when controlling for baseline cortisol, sex, BMI, pubertal development, race and perceived stress (β = −0.04 ± 0.02; p = 0.04). ConclusionFindings from this study identified cross-sectional association between community violence and HPA dysregulation in adolescents who were overweight/obese. If long-term exposure to community violence does indeed accelerate HPA dysregulation in adolescents at increased weight status, policymakers and interventionists should consider implementing programs that limit adolescent violence exposure.

Cortisol awakening response in PTSD treatment: Predictor or mechanism of change

PTSD is associated with abnormalities in hypothalamic-pituitary-adrenal (HPA) axis activity. This includes enhanced HPA axis negative feedback, attenuated cortisol awakening response, and attenuated cortisol response to personal trauma script. Whether HPA axis function predicts treatment response or treatment related symptom reduction in PTSD remains unclear. In addition, the relative effects of different treatment modalities (i.e., medication and psychotherapy) on HPA axis is unclear. To address this gap in knowledge, the PROGrESS study examined cortisol awakening response across treatment in Veterans with chronic PTSD randomized to receive Prolonged Exposure + Placebo (PE + PLB), Sertraline + PE (SERT + PE) or Sertraline + Enhanced Medication Management (SERT + EMM). Salivary cortisol awakening response (CAR) was assessed at baseline, mid-treatment (week 6 and 12), post-treatment (week 24) and follow-up (week 36 and 52). Among males at baseline, combat veterans with PTSD showed lower CAR Area Under the Curve Increase (AUCi; M = 3.15, SD = 9.57) than Combat controls (M = 7.63, SD = 9.07; p = .02), demonstrating combat veterans with PTSD have a less responsive system than combat controls. Higher PTSD severity was also related to lower CAR AUCi (r = -0.52, p = .03). When controlling for PTSD severity, higher baseline CAR AUCi was related to attenuated reduction in PTSD and lower likelihood of high treatment response over treatment (z = -2.06, p = .04).

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression.

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.

Cortisol reactivity to a psychosocial stressor significantly increases the risk of developing Cognitive Impairment no Dementia five years later

Alzheimer’s disease (AD) patients show high cortisol levels suggesting that biological mediators of stress may play a role in the neurodegenerative process of cognitive disorders. However, there is no consensus as to whether cortisol concentrations represent a risk factor for the development of cognitive impairment. We analyzed the potential association between the incidence of cognitive impairment and cortisol concentrations under basal and acute stress conditions in 129 individuals aged 50 years or older, with preserved cognitive and functional abilities. All participants were recruited in 2011 for assessment of cognitive performance and cortisol levels. Cortisol was analyzed in saliva samples collected during two typical and consecutive days, in the morning, afternoon, and night, and also during exposure to an acute psychosocial stressor (Trier Social Stress Test – TSST). After a five-year follow-up, 69 of these volunteers were reassessed for cognitive performance, functional evaluation, memory complaints, and depression. The incidence of cognitive impairment not dementia (CIND) was 26.1 %, and was positively associated with greater TSST-induced cortisol release (responsiveness) [(95 % CI = 1.001–1.011; B = 0.006), p = 0.023]. Moreover, five years before diagnosis, participants who later developed CIND had greater responsiveness to TSST (p = 0.019) and lower cortisol awakening response (CAR: p = 0.018), as compared to those who did not develop CIND. These findings suggest that higher psychosocial stress responsiveness profiles may represent a preclinical sign of cognitive impairment.

Low- and High-Altitude Cortisol Awakening Responses Differ Between AMS-Prone and AMS-Resistant Mountaineers.

Background: Mechanisms underlying acute mountain sickness (AMS) remain unclear. Corticosteroids are effective for prevention and treatment suggesting a role for deficient endogenous cortisol. The cortisol awakening response (CAR), the increase in cortisol secretion over the first 30-45 minutes after morning awakening, better reflects the hypothalamic-pituitary-adrenal (HPA) axis than single cortisol measurements. We hypothesized that CAR may be altered in AMS-prone persons. Methods: Upon arrival at 4554 m (high altitude [HA]), 81 mountaineers agreed to participate. The following morning, they gave three saliva samples after awakening (S1: 0 minute, S2: 30 minutes, S3: 45 minutes). AMS was scored with the 1993 Lake Louise Score (LLS, cut-off ≥5). Minimally 4 weeks after descent, saliva was recollected by 58 of 81 participants at low altitude (LA); 382 ± 309 m, mean ± standard deviation). Cortisol was quantified by immunoassay. Three cortisol indices were analyzed: first sample on awakening (S1), CAR (area under curve with respect to S1) and total post awaking cortisol (area under the curve from ground [AUC-G]). Results: AMS prevalence was 30%. At HA compared to LA, S1 (450 ± 190 vs. 288 ± 159 ng/dL, p < 0.001) and AUC-G (387 ± 137 vs. 276 ± 114 ng/dL·min, p < 0.001) were greater, but CAR was not (50 ± 100 vs. 60 ± 81 ng/dL·min, p = 0.550). AMS+ compared to AMS- participants had higher S1 both at HA (495 ± 209 vs. 384 ± 176 ng/dL, p = 0.016) and LA (354 ± 160 vs. 253 ± 142 ng/dL, p = 0.015) and lower CAR at LA (24 ± 87 vs. 79 ± 72 ng/dL·min, p = 0.013). AUC-G was similar in both groups at HA and LA. Conclusions: Some indices of salivary cortisol response upon awakening differ between AMS+ and AMS-, both at HA and LA, suggesting a link between HPA-axis homeostasis and AMS.

The influence of mindfulness and social support on stress reactivity during pregnancy.

Exaggerated stress reactivity can lead to negative health outcomes, which can be especially harmful during important periods of development such as pregnancy. Therefore, studies are needed to examine potential protective factors associated with lower perceived stress reactivity and lower cortisol awakening response (CAR) during pregnancy. The current cross-sectional study examined whether low-income women (n=152) with higher mindfulness (attentiveness and awareness of the present moment) and more perceived social support had lower levels of perceived stress reactivity and a lower CAR during pregnancy. Women completed self-report measures of mindfulness (Mindful Attention Awareness Scale), social support (Medical Outcomes Study-Social Support Scale), and perceived stress reactivity (Perceived Stress Reactivity Scale) during their first trimester of pregnancy and collected saliva using the passive drool procedure at home (at awakening and at 30min after awakening). Results showed that women with greater mindfulness and greater perceived social support had significantly lower perceived stress reactivity, but not a lower CAR. These results provide preliminary support for mindfulness and social support as potential protective factors of perceived stress reactivity and have implications for experimental studies aimed at improving pregnant women's mindfulness and social support for reducing their stress reactivity and potentially improving health outcomes.