Diurnal profiles of salivary cortisol and alpha-amylase change across the adult lifespan: evidence from repeated daily life assessments

"What's yours is mine": Partners' everyday emotional experiences and cortisol in older adult couples

The existing literature consistently finds that emotional experiences and cortisol secretion are linked at the within-person level. Further, relationship partners tend to covary in emotional experience, and in cortisol secretion. However, we are only beginning to understand whether and how an individuals' emotions are linked to their relationship partners' cortisol secretion. In this project, we harmonized data from three intensive measurement studies originating from Canada and Germany to investigate the daily dynamics of emotions and cortisol within 321 older adult couples (age range=56-87 years). Three-level multilevel models accounted for the nested structure of the data (repeated assessments within individuals within couples). Actor-Partner Interdependence Models were used to examine the effect of own emotional experiences (actor effects) and partner emotional experiences (partner effects) on momentary and daily cortisol secretion. Adjusting for age, sex, education, comorbidities, assay version, diurnal cortisol rhythm, time spent together, medication, and time-varying behaviors that may increase cortisol secretion, results suggest that higher relationship partner's positive emotions are linked with lower momentary cortisol and total daily cortisol. Further, this association was stronger for older participants and those who reported higher relationship satisfaction. We did not find within-couple links between negative emotions and cortisol. Overall, our results suggest that one's relationship partner's positive emotional experience may be a protective factor for their physiological responding, and that these more fleeting and day-to-day fluctuations may accumulate over time, contributing to overall relationship satisfaction.

Sleep Composition of Patients With Colorectal Cancer and Their Sleep-Partner Caregivers: Physical Health Correlates of Sleep Diary and Actigraphy Measurements

BACKGROUND

Disturbed sleep is frequently identified in adult patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraph-measured sleep patterns are similar between patients and their sleep-partner caregivers, and how these different modes of sleep measurements are related to physical health.

METHODS

Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads) completed a questionnaire for physical functioning and collected saliva samples for seven consecutive days, from which cortisol slope was quantified. Additionally, participants completed a daily sleep diary and wore actigraph for 14 consecutive days, from which sleep duration, sleep onset latency (SOL), and duration of wake after sleep onset (WASO) were calculated.

RESULTS

Participants reported sleep patterns that fell within or close to the optimal range, which were similar between patients and their caregivers. Self-reported and actigraph-measured sleep duration had moderate levels of agreement (ICC = 0.604), whereas SOL and WASO had poor agreement (ICC = 0.269). Among patients, longer self-reported WASO was associated with poorer physical health and flatter cortisol slope (p ≤ 0.013). Among caregivers, longer self-reported SOL was associated with poorer physical functioning, actigraph-measured WASO was associated with steeper cortisol slope, and longer self-reported sleep markers studied than actigraph-measured were associated with poorer physical functioning (p ≤ 0.042).

CONCLUSION

Findings suggest that employing multiple assessment modes for sleep and physical health is vital for comprehensive understanding of sleep health. Furthermore, when addressing patients' sleep health, it may be beneficial to include their sleep-partner caregivers who may experience similar disturbed sleep.

Salivary alpha-amylase stress reactivity in advanced-aged marmosets (Callithrix jacchus): Impacts of cognitive function and oral health status

Salivary alpha-amylase (sAA) is an enzyme found in saliva and is considered a noninvasive biomarker for sympathetic nervous system activity. While a wide range of sAA activity in response to stress has been reported in nonhuman primates, the effects of stress on sAA activity in common marmosets are still unknown. We tested the hypothesis that advanced age and cognitive function may have an impact on stress-related sAA reactivity in marmosets. Thirteen marmosets (nine males and five females) had saliva samples collected during a stressful condition (manual restraint stress) at two different time points, with a 60-min interval. On the next day, the animals underwent the object recognition test (ORT, a type of cognitive test), and then oral examinations. The animals were categorized into two age groups: old (10-13 years), and very old (15-22 years). Irrespective of age, sAA levels showed a significant difference between T1 (mean 2.07 ± 0.86 U/mL) and T2 samples (mean 1.03 ± 0.67 U/mL), with higher values observed at T1 (p < 0.001). The intra-assay coefficients of variation (CV) for low and high sAA concentrations were 10.79% and 8.17%, respectively, while the interassay CVs for low and high sAA concentrations were 6.39% and 4.38%, respectively. Oral health issues were common but did not significantly impact sAA levels. The ORT indicated that the animals could recognize an object placed in the cage 6 h after familiarization. In conclusion, all marmosets showed a higher sAA concentration in the first saliva sample as compared to the second saliva sample collected 1 h later, indicating adaptation to stress. No significant differences in sAA levels were observed between sexes, ORT performance, or oral health. Our results indicate that autonomic responsivity and cognitive (memory) functions were preserved even in very old marmosets.

Variation in diurnal cortisol patterns among the Indigenous Shuar of Amazonian Ecuador

OBJECTIVES

The hypothalamic-pituitary-adrenal (HPA) axis and its primary end product, the glucocorticoid cortisol, are major components of the evolved human stress response. However, most studies have examined these systems among populations in high-income settings, which differ from the high pathogen and limited resource contexts in which the HPA axis functioned for most of human evolution.

METHODS

We investigated variability in diurnal salivary cortisol patterns among 298 Indigenous Shuar from Amazonian Ecuador (147 males, 151 females; age 2-86 years), focusing on the effects of age, biological sex, and body mass index (BMI) in shaping differences in diurnal cortisol production. Saliva samples were collected three times daily (waking, 30 minutes post-waking, evening) for three consecutive days to measure key cortisol parameters: levels at waking, the cortisol awakening response, the diurnal slope, and total daily output.

RESULTS

Age was positively associated with waking levels and total daily output, with Shuar juveniles and adolescents displaying significantly lower levels than adults (p < .05). Sex was not a significant predictor of cortisol levels (p > .05), as Shuar males and females displayed similar patterns of diurnal cortisol production across the life course. Moreover, age, sex, and BMI significantly interacted to moderate the rate of diurnal cortisol decline (p = .027). Overall, Shuar demonstrated relatively lower cortisol concentrations than high-income populations.

CONCLUSIONS

This study expands the documented range of global variation in HPA axis activity and diurnal cortisol production and provides important insights into the plasticity of human stress physiology across diverse developmental and socioecological settings.

From static to semi-dynamic in vitro digestion conditions relevant for the older population: starch and protein digestion of cooked lentils

In the context of adequately feeding the rising older population, lentils have an important potential as sources of (plant-based) protein as well as slowly digestible bio-encapsulated starch and fibre. This study evaluated in vitro digestion of protein and starch in lentils under conditions representing the gastrointestinal tract of older adults. Both static and semi-dynamic simulations were applied to analyze the effect of specific gastrointestinal conditions (healthy versus older adult) on macronutrient digestion patterns. Gastric proteolysis was strongly dependent on applied gastric pH (gradient), leading to a lower extent of protein hydrolysis for simulations relevant for older adults. Fewer and smaller (lower degree of polymerization, DP) bioaccessible peptides were formed during gastric proteolysis under older adult compared to healthy adult conditions. These differences, developed during the in vitro gastric phase, were compensated during small intestinal digestion, yielding similar final proteolysis levels regardless of the applied simulation conditions. In contrast, in the presence of saliva, amylolysis was generally accelerated under older adult conditions. Moreover, the current work highlighted the importance of considering saliva (or salivary amylase) incorporation in simulations where the applied gastric pH (gradient) allows salivary amylase activity. Under both healthy and older adult conditions, in vitro starch hydrolysis bio-encapsulated in cotyledon cells of cooked lentils was attenuated, compared to a white bread reference.

The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions

The aim of this narrative review is to consolidate knowledge on the role of the hypothalamic-pituitary-adrenal (HPA) axis in depression pathophysiology at different reproductive stages across the female lifespan. Despite growing evidence about the impact of gonadal hormones on mood disorders, no previous review has examined the interaction between such hormonal changes and the HPA axis within the context of depressive disorders in women. We will focus on HPA axis function in depressive disorders at different reproductive stages including the menstrual cycle (e.g., premenstrual dysphoric disorder [PMDD]), perinatally (e.g., postpartum depression), and in perimenopausal depression. Each of these reproductive stages is characterized by vast physiological changes and presents major neuroendocrine reorganization. The HPA axis is one of the main targets of such functional alterations, and with its key role in stress response, it is an etiological factor in vulnerable windows for depression across the female lifespan. We begin with an overview of the HPA axis and a brief summary of techniques for measuring HPA axis parameters. We then describe the hormonal milieu of each of these key reproductive stages, and integrate information about HPA axis function in depression across these reproductive stages, describing similarities and differences. The role of a history of stress and trauma exposure as a contributor to female depression in the context of HPA axis involvement across the reproductive stages is also presented. This review advances the pursuit of understanding common biological mechanisms across depressive disorders among women. Our overarching goal is to identify unmet needs in characterizing stress-related markers of depression in women in the context of hormonal changes across the lifespan, and to support future research in women's mental health as it pertains to pathophysiology, early diagnosis, and treatment targets.

Daily biofeedback to modulate heart rate oscillations affects structural volume in hippocampal subregions targeted by the locus coeruleus in older adults but not younger adults

Using data from a clinical trial, we tested the hypothesis that daily sessions modulating heart rate oscillations affect older adults' volume of a region-of-interest (ROI) comprised of adjacent hippocampal subregions with relatively strong locus coeruleus (LC) noradrenergic input. Younger and older adults were randomly assigned to one of two daily biofeedback practices for 5 weeks: (1) engage in slow-paced breathing to increase the amplitude of oscillations in heart rate at their breathing frequency (Osc+); (2) engage in self-selected strategies to decrease heart rate oscillations (Osc-). The interventions did not significantly affect younger adults' hippocampal volume. Among older adults, the two conditions affected volume in the LC-targeted hippocampal ROI differentially as reflected in a significant condition × time-point interaction on ROI volume. These condition differences were driven by opposing changes in the two conditions (increased volume in Osc+ and decreased volume in Osc-) and were mediated by the degree of heart rate oscillation during training sessions.

Effects of cranial electrotherapy stimulation on improving depressive symptoms in people with stress: A randomized, double-blind controlled study

BACKGROUND

Cranial electrotherapy stimulation (CES) is a form of neurostimulation that delivers alternating microcurrent via electrodes on the head. We investigated the effectiveness of CES in reducing stress.

METHODS

Participants who experienced subjective stress combined with subclinical depression or insomnia were recruited based on interviews and questionnaires. The subjects were randomly assigned to the active CES or sham groups and asked to use the device for 30 min twice a day for three weeks. Psychological rating scales, quantitative electroencephalography (QEEG), and serial salivary cortisol levels were measured before and after the intervention.

RESULTS

Sixty-two participants (58 females, mean age = 47.3 ± 8.2 years) completed the trial. After intervention, the depression scores improved significantly to a nearly normal level (Beck depression inventory-II, 31.3 ± 11.6 to 10.8 ± 7.2, p < 0.001) in the CES group, which were greater improvement compared to the sham group (p = 0.020). There were significant group-by-visit interactions in absolute delta power in the temporal area (p = 0.033), and theta (p = 0.038), beta (p = 0.048), and high beta power (p = 0.048) in the parietal area. CES led to a flattening of the cortisol slope (p = 0.011) and an increase in bedtime cortisol (p = 0.036) compared to the sham group.

LIMITATIONS

Bias may have been introduced during the process because device use and sample collection were self-conducted by participants at home.

CONCLUSIONS

CES can alleviate depressive symptoms and stress response, showing a potential as an adjunctive therapy for stress.

Daily biofeedback to modulate heart rate oscillations affects structural volume in hippocampal subregions targeted by the locus coeruleus in older adults but not younger adults

Using data from a clinical trial, we tested the hypothesis that daily sessions modulating heart rate oscillations affect older adults' volume of a region-of-interest (ROI) comprised of adjacent hippocampal subregions with relatively strong locus coeruleus (LC) noradrenergic input. Younger and older adults were randomly assigned to one of two daily biofeedback practices for 5 weeks: 1) engage in slow-paced breathing to increase the amplitude of oscillations in heart rate at their breathing frequency (Osc+); 2) engage in self-selected strategies to decrease heart rate oscillations (Osc-). The interventions did not significantly affect younger adults' hippocampal volume. Among older adults, the two conditions affected volume in the LC-targeted hippocampal ROI differentially as reflected in a significant condition x time-point interaction on ROI volume. These condition differences were driven by opposing changes in the two conditions (increased volume in Osc+ and decreased volume in Osc-) and were mediated by the degree of heart rate oscillation during training sessions.

Sex-related differences in the associations between diurnal cortisol pattern and social and emotional loneliness in older adults

Introduction

Loneliness is a distressful feeling that can affect mental and physical health, particularly among older adults. Cortisol, the primary hormone of the Hypothalamic-Pituitary-Adrenal axis (HPA-axis), may act as a biological transducer through which loneliness affects health. While most previous studies have evaluated the association between loneliness, as a unidimensional construct, and diurnal cortisol pattern, no research has examined this relationship discriminating between social and emotional loneliness in older adults. As sex differences in the negative mental health outcomes of loneliness have been reported, we also investigated whether diurnal cortisol indices and loneliness associations occur in a sex-specific manner.

Methods

We analyzed the diurnal cortisol- pattern in 142 community-dwelling, non-depressed, Caucasian older adults (55,6% female) aged 60-90. Social and emotional (family and romantic) loneliness scores were assessed using the Spanish version of the Social and Emotional Loneliness Scale for Adults (SELSA). Five salivary cortisol samples were used to capture key features of the diurnal cortisol pattern, including: awakening and bedtime cortisol levels, awakening response (CAR), post-awakening cortisol output (post-awakening cortisol [i.e., the area under the curve with reference to the ground: AUCG]), total diurnal cortisol release (AUCG), and diurnal cortisol slope (DCS).

Results

After controlling for sociodemographic variables, the hierarchical linear multiple regression analyses revealed that in male older adults, higher scores on social and family loneliness were associated with elevated awakening cortisol levels, total diurnal cortisol output, and a steeper diurnal cortisol slope (DCS). However, these associations were not observed in female older adults. In addition, feelings of romantic loneliness were positively associated with bedtime cortisol levels and AUCG in older males. Multilevel growth curve modeling showed that experiencing more social and emotional loneliness predicted higher diurnal cortisol output throughout the day in older male adults.

Discussion

The presence of sex differences in the relationship between cortisol indices and loneliness among older adults holds particular significance for diagnostic and screening procedures. Combining loneliness scales as screening tools with diurnal cortisol measures has the potential to be an effective and cost-efficient approach in identifying higher-risk individuals at early stages.

Salivary cortisol as a marker for assessing the problem-focused coping style of stressed students during the first year of university: An experimental study

Background and Aims

First-year students encounter substantial stress when they enter university. Their mental health often depends upon how well they cope with the stress of university life. Salivary components are well known to reflect the stress status of the students; however, the relationship between salivary components and coping styles remains unknown.

Methods

In this study, 54 healthy first-year students voluntarily completed a questionnaire that addressed three different coping styles: problem-focused, emotion-focused, and escape-focused. We simultaneously collected salivary samples from students in the classroom and measured concentrations of salivary cortisol and α-amylase by enzyme-linked immunosorbent assays over 4 months.

Results

We examined the relationship between coping style and salivary cortisol concentrations and found that the mean salivary cortisol concentrations were significantly lower in students who had a higher Likert-type score for the problem-focused coping style than in students who had a lower score. The difference in the mean cortisol concentrations between the two groups increased over time. However, we observed no apparent correlation between α-amylase concentrations and Likert scores of the three coping styles.

Conclusion

These results suggest that salivary cortisol concentrations might reflect the stress-coping status, particularly involving the problem-focused coping style.

Transcutaneous Auricular Vagus Nerve Stimulation in Pediatric Patients: A Systematic Review of Clinical Treatment Protocols and Stimulation Parameters

BACKGROUND

Noninvasive transcutaneous vagus nerve stimulation (tVNS) has promising therapeutic potential in a wide range of applications across somatic and psychiatric conditions. Compared with invasive vagus nerve stimulation, good safety and tolerability profiles also support the use of tVNS in pediatric patients. Potential neurodevelopment-specific needs, however, raise concerns regarding the age-appropriate adjustment of treatment protocols and applied stimulation parameters.

OBJECTIVE

In this study, we aimed to review registered trials and published studies to synthesize existing tVNS treatment protocols and stimulation parameters applied in pediatric patients.

MATERIALS AND METHODS

A systematic search of electronic data bases (PubMed, Scopus, MEDLINE, Cochrane Library, and PsycINFO) and ClinicalTrials was conducted. Information on patient and study-level characteristics (eg, clinical condition, sample size), the tVNS device (eg, brand name, manufacturer), stimulation settings (eg, pulse width, stimulation intensity), and stimulation protocol (eg, duration, dosage of stimulation) was extracted.

RESULTS

We identified a total of 15 publications (four study protocols) and 15 registered trials applying tVNS in pediatric patients (<18 years of age). Most of these studies did not exclusively address pediatric patients. None of the studies elaborated on neurodevelopmental aspects or justified the applied protocol or stimulation parameters for use in pediatric patients.

CONCLUSIONS

No dedicated pediatric tVNS devices exist. Neither stimulation parameters nor stimulation protocols for tVNS are properly justified in pediatric patients. Evidence on age-dependent stimulation effects of tVNS under a neurodevelopment framework is warranted. We discuss the potential implications of these findings with clinical relevance, address some of the challenges of tVNS research in pediatric populations, and point out key aspects in future device development and research in addition to clinical studies on pediatric populations.

The relationship between frailty and community-acquired pneumonia in older patients

PURPOSES

To explore the relationship between frailty and community-acquired pneumonia (CAP) in older patients.

METHODS

A prospective observational study included 109 older patients(≥ 65 years) hospitalized with CAP in respiratory department of Fuxing hospital, Capital Medical University from June 2018 to December 2020. Frailty scores(Frail Scale, range 0-5) and pneumonia severity CURB-65 scale(mild = 1, modest = 2, and severe ≥ 3) were measured. We extracted clinical variables including white blood cell(WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein(CRP), hemoglobin, and albumin. Charlson Comorbidity Index(CCI) was calculated as well. The correlations between the variables and frailty scores were investigated, respectively. After adjusting for covariates, binomial logistic regression analysis was used to assess independent effect of frailty scores on the outcome(discharge or death/progression) in older CAP patients.

RESULTS

The subjects had a median age 87(interquartile range,8.5) years, 60.6% male, 45.9% pre-frail, and 32.1% frail. There were positive correlations between frailty scores and CURB-65 scale (p = 0.000, r = 0.542), CCI(p = 0.000, r = 0.359) and NLR(p = 0.005, r = 0.268). Negative correlations were observed between frailty scores and hemoglobin (p = 0.002, r = - 0.298), albumin (p = 0.000, r = - 0.465). In multivariable logistic regression analysis, the factors associated with discharge or death/progression of CAP were frailty scores (OR = 1.623, p = 0.037), NLR (OR = 1.086, p = 0.008) and albumin (OR = 0.869, p = 0.034).

CONCLUSIONS

Frailty is correlated with CURB-65 scale, CCI and hemoglobin, and albumin in older patients with CAP. Frailty is also a correlate of increased risk for death or progression in these older people.

Alterations of the gut microbiota in type 2 diabetics with or without subclinical hypothyroidism

Background

Diabetes and thyroid dysfunction are two closely related endocrine diseases. Increasing evidences show that gut microbiota plays an important role in both glucose metabolism and thyroid homeostasis. Meanwhile, copy number variation (CNV) of host salivary α-amylase gene (AMY1) has been shown to correlate with glucose homeostasis. Hence, we aim to characterize the gut microbiota and CNV of AMY1 in type 2 diabetes (T2D) patients with or without subclinical hypothyroidism (SCH).

Methods

High-throughput sequencing was used to analyze the gut microbiota of euthyroid T2D patients, T2D patients with SCH and healthy controls. Highly sensitive droplet digital PCR was used to measure AMY1 CN.

Results

Our results revealed that T2D patients have lower gut microbial diversity, no matter with or without SCH. The characteristic taxa of T2D patients were Coriobacteriales, Coriobacteriaceae, Peptostreptococcaceae, Pseudomonadaceae, Collinsella, Pseudomonas and Romboutsia. Meanwhile, Escherichia/Shigella, Lactobacillus_Oris, Parabacteroides Distasonis_ATCC_8503, Acetanaerobacterium, Lactonifactor, uncultured bacterium of Acetanaerobacterium were enriched in T2D patients with SCH. Moreover, serum levels of free triiodothyronine (FT3) and free thyroxine (FT4) in T2D patients were both negatively correlated with richness of gut microbiota. A number of specific taxa were also associated with clinical parameters at the phylum and genus level. In contrast, no correlation was found between AMY1 CN and T2D or T2D_SCH.

Conclusion

This study identified characteristic bacterial taxa in gut microbiota of T2D patients with or without SCH, as well as the taxa associated with clinical indices in T2D patients. These results might be exploited in the prevention, diagnosis and treatment of endocrine disorders in the future.

Relations among CRFR1 and FKBP5 genotype, cortisol, and cognitive function in aging humans: A Project FRONTIER study

Here we use the glucocorticoid cascade hypothesis framework to address the role of baseline cortisol on changes in cognitive function over a 3-year span in non-demented rural Americans. We also determine if genotype at 4 different single nucleotide polymorphisms (SNPs) relates to change in cognitive function. We predicted 1) over time, increases in baseline cortisol will be associated with decline in cognitive function, 2) individuals homozygous for 3 CRFR1 SNP rare alleles (AA rs110402, TT rs7209436, and TT rs242924 vs. others) will show less cognitive decline and this will be particularly pronounced in those with lower baseline cortisol, and 3) FKBP5 T carriers (TT or CT vs. CC homozygotes) will have decreased cognitive performance and this will be particularly pronounced in individuals with higher baseline cortisol. Collectively, our data do not robustly support the glucocorticoid cascade hypothesis. In several cases, higher baseline cortisol related to better cognitive performance over time, but within individuals, increased cortisol over time related to decreased performance on some cognitive domains over time. Contrary to our predictions, individuals with the rare CRFR1 haplotype (AA, TT, TT) performed worse than individuals with the common haplotype across multiple domains of cognitive function. FKBP5 genotype status had minimal impacts on cognitive outcomes. Genotype effects were largely not dependent on cortisol. The Project FRONTIER dataset is supported by Texas Tech University Health Sciences Center Garrison Institute on Aging.

The association between circadian rhythm of cortisol and shift work regularity among midwives-A multicenter study in Southeast China

Objective

This article aims to explore the association between the trends of cortisol rhythm and the regularity of shift work among midwives.

Methods

Midwives from six Southeast Chinese hospitals were recruited through cluster sampling in a multi-center cross-sectional study. Urine samples were collected half an hour after waking up, at 11:00, 19:00, and 23:00 on two consecutive days in a longitudinal cohort. The urinary cortisol was assayed by the chemiluminescence method.

Results

A total of 86 midwives were included in this study, contributing 688 cortisol samples. The midwives displayed a circadian rhythm in cortisol secretion, with zeniths in the morning and nadirs in the evening. The trend of the first day was repeated on the second day. Although the total working hours per week of the two groups, namely the regular shift group (N = 43) and the irregular shift group (N = 43), were the same, significant main effects of groups (F = 62.569, p < 0.001), time (F = 45.304, p < 0.001), and group-by-time interaction (F = 226.695, p < 0.001) were indicated through linear mixed models. The main effect of day was not statistically significant, with F = 0.105 and p = 0.746. The fluctuation range of cortisol curve in the group with irregular schedules was slightly lower than that in the group with regular schedules.

Conclusion

Our results may indicate that cortisol was more inhibited in midwives with irregular shift patterns than those with regular shift patterns. It is necessary to further study the relationship between cortisol rhythm and patterns of midwives' shifts in future so as to lay a foundation for hospital managers to develop a more reasonable scheduling system for midwives with the further purpose to minimize their occupational fatigue and ensure the safety of mothers and infants.

Baseline states of mind differentially affected diurnal salivary stress biomarkers: A preliminary study

The study aimed to determine how different baseline states of mind in each day (relaxed, ordinary, or stressful) affected the diurnal patterns of three commonly investigated salivary stress biomarkers: cortisol (sCort), alpha-amylase (sAA), and chromogranin A (sCgA). A total of 32 healthy volunteers collected saliva on three different mood days at six time points each day (awakening, 30 min after, 10:00, 12:00, 16:00, and 19:00 h). Pulse rates and subjective feeling of stress using a visual analog scale (VAS) were also recorded. The levels of sCort and sAA were highest on a stressful day at certain time points. The levels of sAA were lowest on a relaxing day in the afternoon. Surprisingly, sCgA levels showed an opposite pattern with the highest level seen on a relaxing day. Of note was that the majority of the participants chose a day during a meditation retreat as their relaxing day and participants practicing mindfulness manifested lower levels of sCort (p = 0.003) and sAA (p = 0.043) at 19:00 h compared with those choosing a general leisure day as their relaxing day. Different states of mind were associated with different courses of salivary stress biomarkers. sCort and sAA are the most reliable markers showing the expected trend with higher levels on a stressful day and lower levels on a relaxing day. While the current result cast doubt on the use of sCgA as a stress marker since it was the only marker that showed the opposite trend compared with those of the other two markers as well as pulse rates and VAS. Furthermore, this is the first study to demonstrate that mindfulness practice might have different effects on these biomarkers from just a general relaxed state of mind.

Physical Activity Influences Cortisol and Dehydroepiandrosterone (Sulfate) Levels in Older Adults: A Systematic Review and Meta-Analysis

Age-related changes affect the ratio between two steroid hormones of the hypothalamic-pituitary-adrenal axis, cortisol and dehydroepiandrosterone (sulfate) (DHEA[S]). Physical activity (PA) may buffer the effects of chronic stress and counteract the aging decline of DHEA(S). Therefore, a systematic review was conducted to understand how PA influences physiological markers of cortisol and/or DHEA(S) and whether there is a difference in observational associations or experimental effects in older adults aged 65 years and older. A narrative synthesis was performed on nine observational studies, and meta-analyses were performed on 22 randomized controlled trials. There was low- to moderate-quality evidence that regular PA beneficially reduces cortisol and increases DHEA(S) levels. Subgroup analyses showed no clinically important differences between men and women, different exercise modalities, or health states. The findings cautiously suggest that regular PA of older adults' own choice that they find enjoyable could be recommended to improve cortisol and/or DHEA(S) levels.

Sleep in Normal Aging

Sleep is a key determinant of healthy and cognitive aging. Sleep patterns change with aging, independent of other factors, and include advanced sleep timing, shortened nocturnal sleep duration, increased frequency of daytime naps, increased number of nocturnal awakenings and time spent awake during the night, and decreased slow-wave sleep. The sleep-related hormone secretion changes with aging. Most changes seem to occur between young and middle adulthood; sleep parameters remain largely unchanged among healthy older adults. The circadian system and sleep homeostatic mechanisms become less robust with normal aging. The causes of sleep disturbances in older adults are multifactorial.

Impact of Cortisol on Reduction in Muscle Strength and Mass: A Mendelian Randomization Study

CONTEXT

Prolonged exposure to pathological cortisol, as in Cushing's syndrome causes various age-related disorders, including sarcopenia. However, it is unclear whether mild cortisol excess, for example, accelerates sarcopenia due to aging or chronic stress.

OBJECTIVE

We used Mendelian randomization (MR) analysis to assess whether cortisol was causally associated with muscle strength and mass.

METHODS

Three single-nucleotide polymorphisms associated with plasma cortisol concentrations in the CORtisol NETwork consortium (n = 12 597) were used as instrumental variables. Summary statistics with traits of interest were obtained from relevant genome-wide association studies. For the primary analysis, we used the fixed-effects inverse-variance weighted analysis accounting for genetic correlations between variants.

RESULTS

One SD increase in cortisol was associated with SD reduction in grip strength (estimate, -0.032; 95% CI -0.044 to -0.020; P = 3e-04), whole-body lean mass (estimate, -0.032; 95% CI, -0.046 to -0.017; P = 0.004), and appendicular lean mass (estimate, -0.031; 95% CI, -0.049 to -0.012; P = 0.001). The results were supported by the weighted-median analysis, with no evidence of pleiotropy in the MR-Egger analysis. The association of cortisol with grip strength and lean mass was observed in women but not in men. The association was attenuated after adjusting for fasting glucose in the multivariable MR analysis, which was the top mediator for the association in the MR Bayesian model averaging analysis.

CONCLUSION

This MR study provides evidence for the association of cortisol with reduced muscle strength and mass, suggesting the impact of cortisol on the development of sarcopenia.

Physical Intimacy in Older Couples' Everyday Lives: Its Frequency and Links with Affect and Salivary Cortisol

OBJECTIVES

Physical intimacy is important for communicating affection in romantic relationships. Theoretical and empirical work highlights linkages between physical intimacy, affect, and physiological stress among young and middle-aged adults, but not older adults. We examine physical intimacy and its associations with positive and negative affect and cortisol levels in the daily lives of older couples.

METHOD

We applied actor-partner multilevel models to repeated daily life assessments of physical intimacy (experienced and wished) and affect obtained six times a day over seven consecutive days from 120 older heterosexual German couples (Mage= 71.6, SDage= 5.94). Physiological stress was indexed as total daily cortisol output, the area under the curve with respect to ground (AUCg).

RESULTS

Physical intimacy experienced and wished were reported at the vast majority of occasions, but to different degrees at different times. Within persons, in moments when participants experienced more physical intimacy, older women reported less negative affect, whereas older men reported more positive affect. Between persons, higher overall levels of physical intimacy experienced were associated with higher positive affect and less negative affect among women and with lower daily cortisol output among men. A stronger wish for intimacy was related to more negative affect among both women and men, and to higher daily cortisol output among men.

DISCUSSION

Physical intimacy is linked with mood and stress hormones in the daily life of older couples. We consider routes for future inquiry on physical intimacy among older adults.

Salivary Cortisol Reaction Norms in Zoo-Housed Great Apes: Diurnal Slopes and Intercepts as Indicators of Stress Response Quality

Simple Summary

Changes in cortisol fluctuations are used for stress monitoring. Methodologically, this is straight forward, because sample collection is simple and analytical methods advanced, but since cortisol is primarily a hormone that facilitates energy allocation, the interpretation of these measures is often complex. Acute elevations in cortisol levels are not per se bad, but may constitute an adaptive coping mechanism. Likewise, low cortisol levels do not always indicate the absence of a stressor. To distinguish between stress response qualities, a more fine-grained analyses of cortisol fluctuations is warranted. Cortisol excretion follows a diurnal pattern with high levels in the morning, decreasing throughout the day. Two regression coefficients describe this curve: the intercept (the constant with which levels change throughout the day) and the slope (curve steepness and direction). We assessed salivary cortisol intercepts and slopes in zoo-housed apes on routine days, enrichment days, and in the new ape house. While cortisol excretion increased on enrichment days, the daily decline of cortisol levels was not affected. The move to the new house seemingly was a major stressor as cortisol levels increased slightly and the circadian cortisol decrease was impaired. The combination of intercept and slope measures can differentiate between stress responses, thereby constituting a useful tool for stress monitoring.

Abstract

Monitoring changes in cortisol levels is a widespread tool for measuring individuals’ stress responses. However, an acute increase in cortisol levels does not necessarily denote an individual in distress, as increases in cortisol can be elicited by all factors that signal the need to mobilize energy. Nor are low levels of cortisol indicative for a relaxed, healthy individual. Therefore, a more fine-grained description of cortisol patterns is warranted in order to distinguish between cortisol fluctuations associated with different stress response qualities. In most species, cortisol shows a distinct diurnal pattern. Using a reaction norm approach, cortisol levels across the day can be described by the two regression coefficients: the intercept and the slope of the curve. We measured immunoreactive salivary cortisol in three zoo-housed ape species under three conditions (routine days, enrichment days, and after the move to a new house). We examined salivary cortisol intercepts (SCI) and salivary cortisol slopes (SCS) of the diurnal curves. SCI and SCS were independent from each other. SCI was highest on enrichment days and lowest on routine days. SCS was steep on routine days and blunted after the move. Only SCI was species-specific. Our study provides evidence that combining SCI and SCS measures allows us to differentiate between types of stress responses, thereby constituting a useful tool for welfare assessment.

Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study

Background: Perimenopause is characterized by a decline in the steroid hormones, estradiol, and progesterone. By contrast, the steroid hormone cortisol, a marker of the hypothalamic–pituitary–adrenal (HPA) axis, increases. Recent longitudinal studies reported fluctuations in steroid hormone levels during perimenopause, and even increases in estradiol levels. To understand these confounding results, it is necessary to conduct a longitudinal, highly standardized assessment of steroid hormone secretion patterns in perimenopausal women.

Methods: This longitudinal study investigated 127 perimenopausal women aged 40–56 years for 13 months. Estradiol, progesterone, and cortisol were assessed using saliva samples, which were collected for two (during months 2 and 12 for estradiol and progesterone) or three (during months 2, 7, and 12 for cortisol) non-consecutive months over the course of the study. A total of 14 saliva samples per participant were analyzed to investigate the courses of estradiol and progesterone. Cortisol awakening response and fluctuations of cortisol throughout the day were measured using a total of 11 saliva samples per participant (on awakening, +30 min, +60 min, at 12:00 p.m., and before going to bed) for months 2, 7, and 12.

Results: Multilevel analyses revealed variance in intercept and slope across participants for estradiol [intercept: SD = 5.16 (95% CI: 4.28, 6.21), slope: SD = 0.50 (95% CI: 0.39, 0.64)], progesterone [intercept: SD = 34.77 (95% CI: 25.55, 47.31), slope: SD = 4.17 (95% CI: 2.91, 5.99)], and cortisol (intercept: SD = 0.18 (95% CI: 0.14, 0.23), slope: SD = 0.02 (95% CI: 0.01, 0.02)]. Time predicted cortisol levels [b = −0.02, t₍₉₇₉₎ = −6.63, p < 0.0001]. Perimenopausal status (early vs. late) did not predict estradiol [b = −0.36, t₍₁₆₀₈₎ = −0.84, p = 0.400], progesterone [b = −4.55, t₍₁₇₂₃₎ = −0.87, p = 0.385], or cortisol [b = 0.01, t₍₁₁₂₄₎ = 0.61, p = 0.542] scores over time.

Discussion: Our results are consistent with previous findings emphasizing highly individual fluctuations of estradiol and progesterone levels during perimenopause. However, our findings do not suggest a continuous decline during the observed transition phase, implying relatively stable periods of fluctuating hormone levels. Furthermore, given the lack of significant group differences, it may not be necessary to differentiate between early and late perimenopause from the standpoint of hormonal progression.

Relationship of Choroidal Vasculature and Choriocapillaris Flow With Alterations of Salivary α-Amylase Patterns in Central Serous Chorioretinopathy

Purpose

An abnormality in choroidal vasculature is a known factor in the pathogenesis of central serous chorioretinopathy (CSC), a chorioretinal disease affecting mostly middle-aged males. The purpose of the present study was to investigate the role of the autonomic nervous system (ANS) in the pathophysiology of CSC.

Methods

This was a cross-sectional observational study in which characteristic choroidal vasculature metrics were assessed by measuring the subfoveal choroidal thickness (FCT) and the choroidal vascularity index (CVI) using the imaging technique of enhanced-depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT). Furthermore, flow signal void area features were also evaluated in the study population using OCT angiography (OCTA). Diurnal patterns of salivary α-amylase (a-AMY) production, proposed as a marker of autonomic activity, were assessed in an adult male study population affected by acute naïve CSC in comparison with matched healthy controls.

Results

Results include an overall higher diurnal output of salivary a-AMY production, which is in line with the phenomenon of a sympathetic “drive” playing a role in the pathophysiology of CSC, and a flattened diurnal percentage variation in α-AMY in CSC-affected subjects. Furthermore, Pearson's coefficient test revealed statistically significant correlations between salivary α-AMY diurnal percentage variation and selected choroidal imaging biomarkers (FCT, CVI, and flow signal void area). Finally, multiple linear regression analysis identified salivary α-AMY diurnal percentage production as the sole predictor of the CVI and flow signal void area in the study population.

Conclusions

Autonomic nervous system dysregulation was highlighted in CSC patients.

Heart rate variability and subsequent psychological distress among family members of intensive care unit patients

Objective

To determine whether heart rate variability (HRV; a physiological measure of acute stress) is associated with persistent psychological distress among family members of adult intensive care unit (ICU) patients.

Methods

This prospective study investigated family members of patients admitted to a study ICU. Participants’ variability in heart rate tracings were measured by low frequency (LF)/high frequency (HF) ratio and detrended fluctuation analysis (DFA). Questionnaires were completed 3 months after enrollment to ascertain outcome rates of anxiety, depression, and post-traumatic stress disorder (PTSD).

Results

Ninety-nine participants were enrolled (median LF/HF ratio, 0.92 [interquartile range, 0.64–1.38]). Of 92 participants who completed the 3-month follow-up, 29 (32%) had persistent anxiety. Logistic regression showed that LF/HF ratio (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.43, 1.53) was not associated with 3-month outcomes. In an exploratory analysis, DFA α (OR 0.93, 95% CI 0.87, 0.99), α₁ (OR 0.97, 95% CI 0.94, 0.99), and α₂ (OR 0.94, 95% CI 0.88, 0.99) scaling components were associated with PTSD development.

Conclusion

Almost one-third of family members experienced anxiety at three months after enrollment. HRV, measured by LF/HF ratio, was not a predictor of psychologic distress, however, exploratory analyses indicated that DFA may be associated with PTSD outcomes.

Positive and negative affect are associated with salivary cortisol in the everyday life of older adults: A quantitative synthesis of four aging studies

Research on time-fluctuating links between positive affect and cortisol is inconsistent and mostly based on young to middle-aged samples. The current project investigated how moment-to-moment changes in positive and negative affect are associated with moment-to-moment changes in cortisol levels in older adults' daily lives and whether those associations are moderated by differences in health status (as indicated by the number of comorbidities). Affect and cortisol data collected in four separately conducted momentary assessment studies with parallel protocols were pooled to obtain a sample of N=476 individuals aged 56-88 years (M_age=71.9, SD=6.6; 52% female). Participants provided affect reports and collected salivary cortisol 5-7 times a day for a 7-day period and reported the presence of 13 different health conditions. Data were analyzed using multilevel models, with time since waking, daily behaviors associated with cortisol secretion, age, and sex controlled. Feeling more positive affect than usual was associated with lower momentary cortisol. In contrast, feeling more negative affect than usual was associated with higher momentary cortisol. Associations of momentary positive and negative affect with cortisol were weaker among participants in worse as compared to those in better health. Trait positive affectivity was associated with more curvature of waking cortisol profiles and trait negative affectivity was associated with smaller cortisol awakening responses. Findings suggest that HPA axis responses fluctuate with everyday changes in positive and negative affect in older adults, and that higher HPA reactivity may indicate preserved health in this age group.

Diurnal Salivary Cortisol in Sarcopenic Postmenopausal Women: The OsteoLaus Cohort

Sarcopenia, similar to hypercortisolism, is characterized by loss of muscle mass and strength. Cortisol circadian rhythm changes with aging (blunted late-day nadir values) were suggested to contribute to this decline. We aimed to explore the relationship between diurnal salivary cortisol values and sarcopenia diagnosis and its components in postmenopausal women. This is a cross-sectional study within the OsteoLaus population-based cohort in Lausanne (Switzerland). Participants had a body composition assessment by dual X-ray absorptiometry (DXA), a grip strength (GS) measure, and salivary cortisol measures (at awakening, 30 min thereafter, 11 AM (sc-11AM) and 8 PM (sc-8PM)). Associations between salivary cortisol and sarcopenia diagnosed by six different criteria (based on appendicular lean mass (ALM) assessed by DXA, and muscle strength by GS), and its components, were analyzed. 471 women aged > 50 years (63.0 ± 7.5) were included. Various definitions identified different participants as sarcopenic, who consistently presented higher salivary cortisol at 11 AM and/or 8 PM. There were no associations between salivary cortisol levels and ALM measures, either absolute or after correction to height squared (ALM index) or body mass index. GS was inversely correlated to sc-11AM (r = - 0.153, p < 0.001) and sc-8PM (r = - 0.118, p = 0.002). Each 10 nmol/l increase of sc-11AM, respectively sc-8PM, was associated with a GS decrease of 1.758 (SE 0.472) kg, respectively 2.929 (SE 1.115) kg. In postmenopausal women, sarcopenia is associated with higher salivary cortisol levels at 11 AM and 8 PM. An increase of daily free cortisol levels in the physiological range could participate to sarcopenia development by decreasing muscle function in postmenopausal women.

Daily Social Interactions and HPA Axis Activity Among Midlife and Older Adults

BACKGROUND AND OBJECTIVES

Older people experience fewer negative interactions and report less stress in response to interpersonal tensions. Less is known, however, about the implications of daily social interactions for biological stress responses. We evaluated links between daily positive and negative interactions and 2 key biomeasures of the hypothalamic-pituitary-adrenal axis: salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S). We also considered the moderating effects of age.

RESEARCH DESIGN AND METHODS

Participants included a random sample of 93 individuals aged 40-95 who completed 14 days of daily diary interviews and provided saliva samples during 4 of those days.

RESULTS

Three-level piecewise models showed that individuals had higher sustained DHEA-S levels on days after reporting more positive interactions. Young-old adults (60-79) had lower overall DHEA-S on days when they had more negative interactions than oldest-old adults (80 and older). Oldest-old adults showed a flatter decline in DHEA-S on days after they reported more negative interactions compared to midlife adults (40-59). Daily social interactions were not significantly associated with cortisol.

DISCUSSION AND IMPLICATIONS

Strategies to increase positive interactions may help to build physiological resilience to stress, particularly among midlife and young-old adults.

Effects of hydrocortisone and yohimbine on selective attention to emotional cues

INTRODUCTION

Facial expressions contain important affective information, and selective attention to facial expression provides an advantage in the face of loss, stress and danger. In addition, the sympathetic nervous system and hypothalamus-pituitary-adrenal axis mediate the organism's response to loss and danger. Here, we aimed at investigating the influence of sympathetic nervous system and hypothalamus-pituitary-adrenal axis activation on selective attention to affective facial stimuli.

METHODS AND MATERIALS

One hundred-and-four healthy men between 18-35 years old (mean (standard deviation) age: 24.1 (3.5) years) participated in the study. We used a randomised, double-blind, placebo-controlled design. Participants received either: (a) yohimbine, (b) hydrocortisone, (c) yohimbine and hydrocortisone or (d) placebo only and participated in a dot-probe task with sad, happy and neutral faces. We collected salivary samples to measure cortisol and alpha amylase activity in addition to measurements of blood pressure and heart rate. Salivary cortisol served as correlate of hypothalamus-pituitary-adrenal axis activation and salivary alpha amylase activity, blood pressure and heart rate as correlates of sympathetic nervous system activation. Measurements were carried out before and after drug administration.

RESULTS

We did not find a main effect or interaction effect of hydrocortisone or yohimbine administration on selective attention to happy faces. However, we found an interaction of yohimbine and hydrocortisone on selective attention to sad faces. Post-hoc t-test revealed an attentional bias away from sad stimuli and towards neutral faces in the hydrocortisone-only group.

DISCUSSION

Only hydrocortisone administration led to an attentional bias away from sad faces. Future studies should investigate these effects in major depression disorder, as this disorder is characterised by glucocorticoid resistance and increased processing of sad stimuli.

Salivary Cortisol and α-Amylase Production at Awakening is Associated with Positivity (POS) Levels in Healthy Young Subjects

A large variety of positive outcomes including social adjustment, psychological well-being and health, have been recently closely associated with positivity (POS). On the assumption that differences in the POS degree might be associated with different individual neuroendocrine assets that enables people to cope effectively with stress, the present study examined the association between POS, salivary cortisol and α-Amylase (α-Amy) production in a group of healthy male volunteers university students, respectively scoring high (POS-H, N = 10) and low (POS-L, N = 10) in POS. Participants were selected from a larger sample of 300 students of the Medical School at Sapienza University of Rome on the basis of their positivity level: POS was analysed and the upper and lower 25% were invited to participate in this new study. The findings report a distinct salivary cortisol and α-Amy production in the study population: in comparison to the POS-H group, the POS-L subjects presented a lower salivary cortisol awake response (CAR) and a flattened α-Amy production at 30 and 60 min after awakening. In addition, salivary cortisol and α-Amy areas under the curve (AUCs), which were calculated as indicators of the two subclinical biomarkers production during the first hour after awakening, resulted significantly lower in the POS-L group in comparison to the POS-H group. Further studies on larger and different populations are needed to definitively confirm that the different cortisol and α-Amy secretion patterns between POS-H and POS-L individuals is associated with a potentially better capacity to preserving an adequate quality of life in individuals being equipped with a system apparently able to better respond to external and/or internal stimuli. Lastly, a better understanding of the biological correlates of POS is crucial to design psychological interventions able to take advantage of individuals’ assets and thus to integrate and strengthen the efficacy of traditional medications.

Motorcycling performance and sleepiness during an extended ride on a dynamic simulator: relationship with stress biomarkers

OBJECTIVE

Powered two-wheelers (PTW) make up a large proportion of fatal accidents. The aim of this study was to investigate the effects of time-of-day and total sleep deprivation (SD) on simulated motorcycling performance during extended riding sessions (60 min), while evaluating stress mechanisms.

APPROACH

A total of 16 healthy males participated in four simulated motorcycling sessions at 07:00, 11:00, 15:00 and 19:00, including city (8 min), country (2 min) and highway pathways (40 min), after a normal night of sleep and after total SD (30 h), in a randomized counterbalanced order. The recorded motorcycle parameters included: variation of lateral position, number of inappropriate line crossings (ILC), falls, riding errors, speed and speed limit violations. Subject parameters included the number of microsleeps in each pathway, the number of lapses during the 3-min psychomotor vigilance task (PVT-Brief version), and the Karolinska sleepiness scale (KSS) score. Saliva samples were used to assess cortisol (sC), α-amylase (sAA), and chromogranin-A (sCgA). ANOVAs and Pearson's correlation analysis were performed between these variables.

MAIN RESULTS

Most parameters were influenced by an interaction effect between 'Motorcycling pathways' × 'SD' (speed (p < 0.05), legal speed violations (p < 0.01), variation of lateral position (p < 0.001), falls (p < 0.001), EEG-microsleeps (p < 005)). An interaction effect between 'SD' × 'Time-of-day' influenced the number of ILCs (p < 0.01), sC (p < 0.05) and sCgA (p < 0.05) levels. SD affected KSS scores (p < 0.001) and PVT lapses (p < 0.05). The highest disturbances were associated with highway motorcycling simulation.

SIGNIFICANCE

Sleepiness due to circadian or SD and fatigue effects significantly affect riding and increase the risks involved with PTWs. The activation of both stress systems seems not sufficient to alleviate these deleterious effects.

Stress-Related Trajectories of Diurnal Cortisol in Older Adulthood Over 12 Years

OBJECTIVE

Although evidence shows that stress experiences can predict both hyper- and hypo-cortisol regulation, there is a lack of research examining these associations longitudinally. Our study assessed whether levels and increases in psychological stress experiences predicted 12-year changes in circadian cortisol levels (area under the curve; AUC) and cortisol slopes in a sample of community-dwelling older adults.

METHODS

In 2004, 190 community dwelling older adults (57 to 94 years) started providing three days of diurnal cortisol and stress experience data every two years for a total of seven waves of data. All analyses controlled for relevant covariates including: SES, BMI, age, sex, cortisol-related medication, chronic illness, and smoking status.

RESULTS

Growth-curve modeling documented that compared to participants who reported generally lower stress experiences (T-ratio = -5.57, p < .01), their counterparts with higher stress experiences showed significantly steeper declines in cortisol AUC over time (T-ratio = -9.23, p < .01). Higher stress experience was associated with generally flatter cortisol slopes. In addition, among participants with high and increasing stress experience over 12 years, cortisol slopes became increasingly flatter over time (T-ratio = 2.78, p < .01).

CONCLUSIONS

Among individuals with high, as compared to low, levels of chronic stress experience, cortisol levels displayed steeper declines across the study period. Moreover, cortisol slopes became increasingly flatter as a function of high and increasing stress experience. Implications for theory and research on the associations between stress experience and cortisol in the context of longitudinal observations are discussed.

Salivary Cortisol and α-Amylase Production at Awakening is Associated with Positivity (POS) Levels in Healthy Young Subjects

A large variety of positive outcomes including social adjustment, psychological well-being and health, have been recently closely associated with positivity (POS). On the assumption that differences in the POS degree might be associated with different individual neuroendocrine assets that enables people to cope effectively with stress, the present study examined the association between POS, salivary cortisol and α-Amylase (α-Amy) production in a group of healthy male volunteers university students, respectively scoring high (POS-H, N = 10) and low (POS-L, N = 10) in POS. Participants were selected from a larger sample of 300 students of the Medical School at Sapienza University of Rome on the basis of their positivity level: POS was analysed and the upper and lower 25% were invited to participate in this new study. The findings report a distinct salivary cortisol and α-Amy production in the study population: in comparison to the POS-H group, the POS-L subjects presented a lower salivary cortisol awake response (CAR) and a flattened α-Amy production at 30 and 60 min after awakening. In addition, salivary cortisol and α-Amy areas under the curve (AUCs), which were calculated as indicators of the two subclinical biomarkers production during the first hour after awakening, resulted significantly lower in the POS-L group in comparison to the POS-H group. Further studies on larger and different populations are needed to definitively confirm that the different cortisol and α-Amy secretion patterns between POS-H and POS-L individuals is associated with a potentially better capacity to preserving an adequate quality of life in individuals being equipped with a system apparently able to better respond to external and/or internal stimuli. Lastly, a better understanding of the biological correlates of POS is crucial to design psychological interventions able to take advantage of individuals’ assets and thus to integrate and strengthen the efficacy of traditional medications.

Cortisol Synchrony in Older Couples: Daily Socioemotional Correlates and Interpersonal Differences

OBJECTIVE

Social relationships can have positive and negative influences, and these associations are particularly pronounced in old age. This study focuses on everyday interpersonal physiological dynamics (cortisol synchrony) in older couples and investigates its associations with partner presence, positive daily partner interactions, and empathy.

METHODS

We conducted coordinated multilevel analyses using data from two samples of older couples from Vancouver, Canada, and Berlin, Germany (study 1: n = 85 couples aged 60-87 years; study 2: n = 77 couples aged 66-85 years), who completed questionnaires and provided salivary cortisol samples five to seven times daily for 7 days.

RESULTS

Significant dyadic covariation in cortisol (synchrony) was present across studies (study 1/2: b = 0.04/0.03, p < .001/.001). Partner presence was only associated with greater cortisol synchrony in study 1 (b = 0.06, p = .003) but not in study 2 (b = 0.02, p = .187). Cortisol synchrony was higher when partners reported prior positive socioemotional partner interactions (study 1: b = 0.09, p = .005; study 2: b = 0.04, p = .005). There was no statistically significant association between cortisol synchrony and empathic concern (b = 0.01, p = .590) or perspective taking (b = 0.02, p = .065).

CONCLUSIONS

Moments of social bonding are intertwined with physiological synchrony in everyday life. The implications of potential repeated transmission of stress in the context of high synchrony for individual health and relationship functioning warrant further investigation.

Roles of age and sources of cancer caregiving stress in self-reported health and neuroendocrine biomarkers

OBJECTIVE

To investigate the extent to which age and specific sources of caregiving stress are associated with cancer caregivers' health. Methods: New colorectal cancer caregivers (n = 88; age M = 49) reported caregiving stress (i.e., disrupted schedule, lacking family support, financial strain) and mental and physical health, and collected saliva samples assayed for neuroendocrine biomarkers (cortisol and α-amylase). Results: Disrupted daily schedule due to caregiving was associated with poorer self-reported mental health across all ages (B= -4.19, 95% CI: -6.59--1.80, p <.01), and associated with dysregulated cortisol patterns among older caregivers, but with more regulated cortisol patterns among younger caregivers, ps ≤ .01. Across all ages, lacking family support was associated with poorer self-reported physical health (B= -2.13, 95% CI: -4.33--0.07, p <.05), but more regulated α-amylase patterns (B = 2.51, 95% CI: 0.83-4.19, p <.01). Financial strain related to regulated cortisol levels only among older caregivers (B = 5.07, 95% CI: 0.58-9.57, p = .03) and more regulated α-amylase patterns across all ages (B= -25.81, 95% CI: -48.72--2.90, p <.05). Conclusion: Findings suggest that specific sources of caregiver stress manifest in health outcomes distinctly by age, and support the need for targeted psychosocial interventions for cancer caregivers.

Isometric exercise facilitates attention to salient events in women via the noradrenergic system

The locus coeruleus (LC) regulates attention via the release of norepinephrine (NE), with levels of tonic LC activity constraining the intensity of phasic LC responses. In the current fMRI study, we used isometric handgrip to modulate tonic LC-NE activity in older women and in young women with different hormone statuses during the time period immediately after the handgrip. During this post-handgrip time, an oddball detection task was used to probe how changes in tonic arousal influenced functional coordination between the LC and a right frontoparietal network that supports attentional selectivity. As expected, the frontoparietal network responded more to infrequent target and novel sounds than to frequent sounds. Across participants, greater LC-frontoparietal functional connectivity, pupil dilation, and faster oddball detection were all positively associated with LC MRI structural contrast from a neuromelanin-sensitive scan. Thus, LC structure was related to LC functional dynamics and attentional performance during the oddball task. We also found that handgrip influenced pupil and attentional processing during a subsequent oddball task. Handgrip decreased subsequent tonic pupil size, increased phasic pupil responses to oddball sounds, speeded oddball detection speed, and increased frontoparietal network activation, suggesting that inducing strong LC activity benefits attentional performance in the next few minutes, potentially due to reduced tonic LC activity. In addition, older women showed a similar benefit of handgrip on frontoparietal network activation as younger women, despite showing lower frontoparietal network activation overall. Together these findings suggest that a simple exercise may improve selective attention in healthy aging, at least for several minutes afterwards.

Diurnal trajectories of salivary cortisol and α-amylase and psychological profiles in patients with central serous chorioretinopathy

It has been hypothesized that the occurrence of central serous chorioretinopathy (CSC) might be associated with stress. Therefore, our purpose was to investigate the diurnal trajectories of salivary cortisol and α-amylase (α-Amy) - markers of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adrenal-medullary (SAM) system activity, respectively - and psychological profiles in idiopathic acute CSC. This cross-sectional observational case-control study, which included self-reported psychometric questionnaires, was formally approved by the Ethics Committee. Written informed consent was obtained from all participants. Home diurnal saliva collection was scheduled at several timepoints: at awakening, 30 and 60 min later, and at approximately 13:00 h and 20:00 h. Twenty consecutive male subjects with first-episode CSC attending the outpatient clinic of the Retina Medical Service at the Bietti Foundation were enrolled in the study. Twenty age-matched subjects were recruited as controls. After their initial enrollment, 3 subjects per group were excluded. The production of cortisol and α-Amy and the scores on the negative subscale of the Positive/Negative Affect Schedule, the Daily Hassles and Stress Scale and the Beck Depression Inventory were higher in the CSC group than in the control group. To estimate the diurnal trends in the production of salivary cortisol and α-Amy, an equation was derived for each group of the study population. The equations describing the interpolated regression lines gave salivary cortisol and salivary α-Amy slopes that were determined to be significantly different by Student's t-test (cortisol: t = 3.533, p < .001; α-Amy: t = 2.382, p = .018). Furthermore, the area under the curve with respect to the ground (AUC_G) was calculated to summarize repeated salivary biomarker measurements from 07:00 h to 08:00 h for assessment of the cortisol awakening response (CAR) and the α-Amy awakening response (AR). The diurnal cortisol AUC_G and diurnal α-Amy AUC_G were calculated from 07:00 h to 20:00 h. The CAR AUC_G values of the CSC patients were significantly higher than those of the controls. No differences between the two groups were detected for the α-Amy AR AUC_G. The present study adds novel information to the growing body of data suggesting that abnormal diurnal activity of the HPA axis and the SAM system is associated with CSC in susceptible individuals, providing ophthalmologists with a new chronobiological approach for these patients.

Markers of HPA-axis activity and nucleic acid damage from oxidation after electroconvulsive stimulations in rats

OBJECTIVE

Oxidative stress has been suggested to increase after electroconvulsive therapy (ECT), a treatment which continues to be the most effective for severe depression. Oxidative stress could potentially be mechanistically involved in both the therapeutic effects and side effects of ECT.

METHODS

We measured sensitive markers of systemic and central nervous system (CNS) oxidative stress on DNA and RNA (urinary 8-oxodG/8-oxoGuo, cerebrospinal fluid 8-oxoGuo, and brain oxoguanine glycosylase mRNA expression) in male rats subjected to electroconvulsive stimulations (ECS), an animal model of ECT. Due to the previous observations that link hypothalamic-pituitary-adrenal (HPA)-axis activity and age to DNA/RNA damage from oxidation, groups of young and middle-aged male animals were included, and markers of HPA-axis activity were measured.

RESULTS

ECS induced weight loss, increased corticosterone (only in middle-aged animals), and decreased cerebral glucocorticoid receptor mRNA expression, while largely leaving the markers of systemic and CNS DNA/RNA damage from oxidation unaltered.

CONCLUSION

These results suggest that ECS is not associated with any lasting effects on oxidative stress on nucleic acids neither in young nor middle-aged rats.

From Healthy Aging to Frailty: In Search of the Underlying Mechanisms

Population aging is accelerating rapidly worldwide, from 461 million people older than 65 years in 2004 to an estimated 2 billion people by 2050, leading to critical implications for the planning and delivery of health and social care. The most problematic expression of population aging is the clinical condition of frailty, which is a state of increased vulnerability that develops as a consequence of the accumulation of microscopic damages in many physiological systems that lead to a striking and disproportionate change in health state, even after an apparently small insult. Since little is known about the biology of frailty, an important perspective to understand this phenomenon is to establish how the alterations that physiologically occur during a condition of healthy aging may instead promote cumulative decline with subsequent depletion of homoeostatic reserve and increase the vulnerability also after minor stressor events. In this context, the present review aims to provide a description of the molecular mechanisms that, by having a critical impact on behavior and neuronal function in aging, might be relevant for the development of frailty. Moreover, since these biological systems are also involved in the coping strategies set in motion to respond to environmental challenges, we propose a role for lifestyle stress as an important player to drive frailty in aging.

Autonomic Stress Response and Perceived Effort Jointly Inform on Dual Tasking in Aging

The study investigated, through neuroendocrinological, subjective and behavioral assessments, how aging individuals cope with locomotor-cognitive dual-tasking and whether physical activity habits influence the acute response to locomotor-cognitive performance. Seventy-nine healthy participants aged 55–85 years were assessed on locomotor (gait speed, stride length) and cognitive (working memory) performances under single- and dual-task (ST, DT) conditions, and habitual physical activity (daily steps). Rating of perceived exertion (RPE) was assessed immediately after performance. Salivary α-amylase (sAA) was measured prior, immediately and 5 min after performance. Gait and working memory variables, the area under the curve of sAA (AUC) and DT–ST differences (DT effects) were computed. AUC was higher when the ST or DT performance involved a locomotor component and showed a pre-to-post increment after DT only, whereas RPE was higher when performance involved a cognitive component. Daily steps neither predicted sAA, nor RPE. Associations between DT effects on sAA, RPE and performance emerged in high-active participants only. In aging individuals, DT walking elicits an autonomic stress response presumably led by the challenge to share resources relying upon common neural substrates. This autonomic response seems tuned to gait performance and subjective evaluation of effort in those more accustomed to walking.

Osteoporosis from an Endocrine Perspective: The Role of Hormonal Changes in the Elderly

Introduction: Osteoporosis is increasingly prevalent in the elderly, with fractures mostly occurring in women and men who are older than 55 and 65 years of age, respectively. The aim of this review was to examine the evidence regarding the influence of hormones on bone metabolism, followed by clinical data of hormonal changes in the elderly, in the attempt to provide possible poorly explored diagnostic and therapeutic candidate targets for the management of primary osteoporosis in the aging population. Material and methods: An extensive Medline search using PubMed, Embase, and Cochrane Library was performed. Results: While the rise in Thyroid-stimulating hormone (TSH) levels has a protective role on bone mass, the decline of estrogen, testosterone, Insulin-like growth factor 1 (IGF1), and vitamin D and the rise of cortisol, parathyroid hormone, and follicle-stimulating hormone (FSH) favor bone loss in the elderly. Particularly, the AA rs6166 FSH receptor (FSHR) genotype, encoding for a more sensitive FSHR than that encoded by the GG one, is associated with low total body mass density (BMD), independently of circulating estrogen. A polyclonal antibody with a FSHR-binding sequence against the β-subunit of murine FSH seems to be effective in ameliorating bone loss in ovariectomized mice. Conclusions: A complete hormonal assessment should be completed for both women and men during bone loss evaluation. Novel possible diagnostic and therapeutic tools might be developed for the management of male and female osteoporosis.

Psychosocial stress associated with memory performance in older South African adults

Older adults with past or current chronic stress exposure perform poorly on memory assessments and are at higher risk for Alzheimer's disease (AD). In low- or middle-income countries, many older adults are, or have been, exposed to stress-provoking events. Few published studies examine such populations, however, and few take multiple measures of stress. In a sample of South African older adults with mild-to-moderate AD (n = 65) and healthy controls (n = 69), we assessed relations between stress (psychosocial and physiological), memory performance, and patient status. Participants, all aged > 60, were administered the Perceived Stress Scale (a questionnaire assessing subjective psychosocial stress) and the Cambridge Cognitive Examination-Revised (CAMCOG-R; a test battery measuring performance across several cognitive domains). We measured their salivary cortisol concentrations as a proxy for physiological stress. Patients reported significantly higher levels of psychosocial stress than controls, p = .008. Logistic regression showed that psychosocial stress, but not cortisol, predicted AD patient status. CAMCOG-R Memory subscale scores were significantly associated with psychosocial stress, r = -.18, p = .040, but not with cortisol levels. These findings are the first on the topic to emerge from a low-or middle-income country. We replicated findings from previous studies conducted in high-income countries, with data supporting predictions derived from the glucocorticoid cascade/neurotoxicity hypothesis. The results suggest that clinical interventions focused on increasing resilience of older adults to effects of chronic stress may help protect against declining memory performance and reduce the risk for AD.

Acute Physiologic Stress and Subsequent Anxiety Among Family Members of ICU Patients

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Objectives:

The ICU is a complex and stressful environment and is associated with significant psychologic morbidity for patients and their families. We sought to determine whether salivary cortisol, a physiologic measure of acute stress, was associated with subsequent psychologic distress among family members of ICU patients.

Design:

This is a prospective, observational study of family members of adult ICU patients.

Setting:

Adult medical and surgical ICU in a tertiary care center.

Subjects:

Family members of ICU patients.

Interventions:

Participants provided five salivary cortisol samples over 24 hours at the time of the patient ICU admission. The primary measure of cortisol was the area under the curve from ground; the secondary measure was the cortisol awakening response. Outcomes were obtained during a 3-month follow-up telephone call. The primary outcome was anxiety, measured by the Hospital Anxiety and Depression Scale-Anxiety. Secondary outcomes included depression and posttraumatic stress disorder.

Measurements and Main Results:

Among 100 participants, 92 completed follow-up. Twenty-nine participants (32%) reported symptoms of anxiety at 3 months, 15 participants (16%) reported depression symptoms, and 14 participants (15%) reported posttraumatic stress symptoms. In our primary analysis, cortisol level as measured by area under the curve from ground was not significantly associated with anxiety (odds ratio, 0.94; p = 0.70). In our secondary analysis, however, cortisol awakening response was significantly associated with anxiety (odds ratio, 1.08; p = 0.02).

Conclusions:

Roughly one third of family members experience anxiety after an ICU admission for their loved one, and many family members also experience depression and posttraumatic stress. Cortisol awakening response is associated with anxiety in family members of ICU patients 3 months following the ICU admission. Physiologic measurements of stress among ICU family members may help identify individuals at particular risk of adverse psychologic outcomes.

Steroid secretion in healthy aging

Nowadays, people spend a considerable amount of their lives as older adults, but this longer lifespan is often accompanied by an increase in chronic conditions and disease, resulting in reduced quality of life and unprecedented societal and economic burden. Healthy aging is therefore increasingly recognized as a healthcare priority. Physical and mental adaptations to changes over the life course, and the maintenance of well-being, represent pivotal challenges in healthy aging. To capture the complexity of healthy aging, we propose a specific phenotype based on body composition, cognition, mood, and sexual function as indicators of different dimensions of healthy aging. With increasing age, sex hormones as well as glucocorticoids undergo significant alterations, and different patterns emerge for women and men. This review describes age-related patterns of change for women and men, and sheds light on the underlying mechanisms. Furthermore, an overview is provided of the challenges for healthy aging resulting from these age-related steroid alterations. While clinical practice guidelines recommend hormonal treatment only in the case of consistently low hormone levels and symptoms of hormone deficiency, physical exercise and a healthy lifestyle emerge as preventive strategies which can counter age-related hormonal changes and at best prevent chronic conditions.