Background: It has been estimated that one third of dementia cases may be preventable through modifiable lifestyle interventions. Epidemiological evidence suggests a link between stressful life events and aging-related cognitive decline and dementia; however, inherent methodological limitations in examining subjective and biological measures of stress separately leads to interpretive constraints.

Objective: The aim of the current study was to conduct a systematic review of the research literature investigating the effect of perceived and biological measures of stress on dementia risk.

Methods: A systematic review was conducted of cohort, case-control, longitudinal prospective or retrospective studies examining the association between stress and risk of developing dementia. Studies were identified from a systematic search across major electronic databases from inception to February 2020.

Results: Overall, 22 studies were identified including a total of 496,556 participants, approximately 50% were females, with sample sizes ranging from 62-270,977. There was considerable heterogeneity in the definition and measurement of stress. Most of the identified studies reported a significant positive association between stress and dementia risk.

Conclusion: Evidenced from the current review is that personality traits linked to increased perceived stress and elevated reported perceived stress, are associated with greater statistical risk for dementia. However, this review highlights that caution must be exhibited in interpreting these findings, as methodological issues with confounding adjustment may mediate these results. Future research should focus on the investigation of stress on dementia risk with a full range of confounding adjustment, and on biological measures of stress.