Abstract
One of the greatest mental challenges teenagers face today is stress. Stress, both acute
and chronic, are known to pose grave mental and physical impacts for adolescents. This project’s main importance was to examine the physiological and psychological impacts of stress compared to the cognitive impairments due to multiple sclerosis.
To measure chronic stress impacts on brain function, participants completed the Perceived Stress Scale (PSS) to measure their chronic stress, then answered a survey analyzing their daily stressors. This was followed by the Montreal Cognitive Assessment (MoCA) Version 8.1 to measure cognitive function. To study acute stress, participants completed the Trier Social Stress Test (TSST), followed by the MoCA Version 8.2 to measure their cognitive function after they experienced acute stress. Finally, the data was compared to the MoCA scores of those with MS.
Those with a PSS ≥ 27 performed better on the MoCA by 3 points compared to their
low/mid-stress counterparts. Participants completed the MoCA ≈61.8 seconds faster after the TSST, generally had better executive function scores, and faltered in memory. After the PSS, participants scored ≈28.4 on the MoCA. After the TSST, participants scored ≈ 27.6, indicating a decrease of ≈ 1, with the MS MoCA score being ≈27.24 (Charest et al., 2020).
The data supported the hypothesis that participants would increase processing speed and decrease memory after the TSST, but it may be useful to assess more participants, ensuring more statistically significant results.
Introduction
Adolescents today face innumerable sources of stress. A survey done in 2013 shows that around 31% of teenagers report feeling overwhelmed, 30% feel depressed due to stress, 36% feel fatigued, and 23% report skipping meals because of stress (Bethune, 2014). Chronic stress impacts the lives of an estimated 45% of high school students, primarily due to school (Zauderer, 2023). In addition, according to multiple clinical studies, there is a correlation between psychological stress and reduced brain health (Schulz et al., 2023).
Acute Stress
Acute stress, or short-term stress induced by a distressing situation, is known to have both detrimental and beneficial effects on the brain. A study conducted in 2013 demonstrated how acute stress induced by brief, stressful events initiated new nerve cells to arise from stem cells and helped to improve rats’ mental performance. Two weeks after the rats experienced the stressful event, they performed better on a memory test, but not two days after the event (Sanders, 2013).
Short-term stress can contribute to the suppression of immune function as well. A study
conducted in 1994 suggests that short-term stress caused octopamine (the norepinephrine
equivalent in insects) to inadvertently prevent immune activation in certain insects such as crickets (Dhabhar, 2018).
Chronic Stress
Chronic stress, or consistent stress over long periods of time, also tends to have harmful
impacts on the brain. Studies in animals show that chronic stress causes stress-related impacts on the prefrontal cortex as well as changes in neuronal plasticity (Lucassen et al., 2013). Chronic stress can impair long-term memory, attention, and executive function due to its damaging impacts on the hippocampus and prefrontal cortex (Colino, 2022).
Multiple Sclerosis (MS)
Multiple sclerosis (MS) is an autoimmune disease impacting the brain and the central
nervous system. Like any chronic disease, MS can cause multitudinous stressful experiences.
Reversely, stress can affect symptoms of MS. While there is no clear evidence that stress develops MS, those already dealing with MS can have a MS relapse induced by stress, meaning that stress can cause MS symptoms to spontaneously appear or worsen drastically for a period of time (Multiple Sclerosis Trust, 2023).
In terms of cognitive function, MS most commonly impairs information processing speed, immediate and delayed recall or memory, verbal fluency, and executive function (DeLuca et al., 2015). Slowed cognition and cognitive decline are also associated with the disease (Sumowski et al., 2018).
The Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment (MoCA) 30-point test is a frequently used tool
for testing cognitive impairment, especially in those with multiple sclerosis. While it may not be able to diagnose cognitive impairment, it is an effective tool for screening cognitive impairment to get a professional diagnosis if needed (Dautzenberg et al., 2020). Through multiple trials and studies, the MoCA test has been proven to screen cognitive dysfunction in MS patients as well as others with mild cognitive impairment, showing statistically significant results (Dagenais et al., 2013).
Trier Social Stress Test (TSST) (Kirschbaum et al., 1993)
The Trier Social Stress Test (TSST) (Kirschbaum et al., 1993) is a test meant to induce
short-term stress on the participant. It consists of an interview and a mental math portion, both of which are designed to be overwhelming for the subject. It is a reliable alternative to physical stressors, therefore imposing less danger on the participant. After taking the TSST (Kirschbaum et al., 1993), 70-80% of subjects had a large increase in cortisol levels, a stress hormone (Dickerson et al., 2004).
Due to the rise of external pressures and expectations imposed on teenagers today,
including personal relationships, test-taking during school, etc., millions of adolescents face
insurmountable amounts of stress throughout their lifetime, especially between the ages of 13-19. The objective of this project is to understand the cognitive impacts of stress compared to MS, an autoimmune disorder, but more importantly to examine the physiological and psychological impacts of acute and chronic stress. Before experimenting, I believe that for individuals with higher levels of stress, executive functions may falter similarly to MS, but verbal fluency and processing speed may improve.
Method
Materials
The following materials were used for the research and procedures.
- iPad Pro – used for cognitive assessment
- Apple Pencil 2nd Generation – used for writing during the cognitive assessment
- Pen – used for writing during the Trier Social Stress Test
- Paper – used for participant notetaking for the Trier Social Stress Test
- MoCA Cognitive Assessment app for the iPad – used for cognitive assessment
- Timer – used for Trier Social Stress Test
- Perceived Stress Test via Google Forms
- Pre-Existing Stress Survey via Google Forms
Methods
Participants were first tasked to complete an online Perceived Stress Scale via Google Forms designed to measure chronic stress written by Cohen et al. in 1983. This online survey asked participants to answer each of the 10 prompts from 0 to 4, a score of 0 signifying “never,” 1 signifying “almost never,” 2 signifying “sometimes,” 3 signifying “fairly often,” and 4 signifying “very often.” The following questions were taken from Cohen’s Perceived Stress Scale (Cohen et al., 1983).
1. In the last month, how often have you been upset because of something that happened unexpectedly?
2. In the last month, how often have you felt that you were unable to control the important things in your life?
3. In the last month, how often have you felt nervous and stressed?
4. In the last month, how often have you felt confident about your ability to handle your personal problems?
5. In the last month, how often have you felt that things were going your way?
6. In the last month, how often have you found that you could not cope with all the things that you had to do?
7. In the last month, how often have you been able to control irritations in your life?
8. In the last month, how often have you felt that you were on top of things?
9. In the last month, how often have you been angered because of things that happened that were outside of your control?
10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?
The participant’s score was calculated by summing up the numerical responses for prompts 1, 2, 3, 6, 9, and 10, and summing up the reverse responses for prompts 4, 5, 7, and 8 to remove response bias. For example, if a participant responded with a 4 for prompt 5, a score of 0 was used in the calculations. Participants with scores ranging from 0-13 were considered low stress, 14-26 were considered to have moderate stress, and 27-40 were considered to have high stress. Subsequently, participants were asked how much stress they received from academics, extracurriculars, and personal life (Cohen et al., 1983).
Montreal Cognitive Assessment (MoCA) Version 8.1
Once the participant completed the survey, participants able to travel were directed to take the Montreal Cognitive Assessment (MoCA) in the study room located in the Palos Verdes Library District. If they were unable to travel, the same procedure was conducted via Zoom call. The participant was provided with a series of tasks to measure different cognitive functions.
Figure 3.3: Location of experimentation. This image shows the location of all elements of experimentation at the Palos Verdes Library District.
Credit: Palos Verdes Library District
Figure 3.4: Diagram of the experimentation set-up.
Participants were administered the MoCA Duo version of the MoCA application developed by MoCA Montreal. During the first round of the experimentation, the MoCA Version 8.1 version was utilized.
Visuospatial/executive Cognitive Function
The visuospatial/executive cognitive function was examined by 3 tasks. The following prompts were taken from the MoCA Online version written by Dr. Ziad Nasreddine in 1995. First, the subject was instructed by the examiner, “Please draw a line going from a number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A then to 2 and so on. End here [point to (E)].” If the subject successfully drew a line without any lines that crossed, connecting point (E) to point (1), or making errors, one point was allocated to the participant (Nasreddine, 1995).
Shortly after, a cube was shown to the participant. The examiner instructed the subject to, “Copy this drawing as accurately as you can.” If the drawing was drawn 3-dimensional, all lines connected with little to no space, no additional lines, lines relatively parallel with similar length, and the cube’s orientation in space was identical to the original, one point was awarded to the participant. (Nasreddine, 1995).
For the final task in this section, the participant was instructed by the examiner to, “Draw a clock. Put in all the numbers and set the time to 10 past 11.” (Nasreddine, 1995). Any visible watches or clocks were not in sight during this point of the assessment. If the subject was able to draw a clock with a circle or square contour, all numbers were in a circular manner in the correct order (with Roman numerals acceptable), and hands indicated the correct time with the hour hand clearly shorter than the minute hand, the participant was awarded 3 points, one point for each criterion [Fig. 3.1].
Naming
Participants were shown 3 images of animals. From the left, the researcher pointed to each image and instructed, “Tell me the name of this animal.” (Nasreddine, 1995). If the subject answered a lion for the first figure, a rhinoceros or rhino for the second, and a camel or dromedary for the third, one point was awarded to the participant for each correctly named animal [Fig. 3.2].
Memory
For this section, the researcher stated, “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember. It doesn’t matter in what order you saw them.” The researcher read a list of 5 words (face, velvet, church, daisy, red) at one word per second. The participant was then prompted to recite the 5 words they were to remember without aid from the examiner. Whether or not the first trial was successful, the examiner stated, “I am going to read the same list of a second time. Try to remember and tell me as many words as you can, including what you said the first time.” Once the subject repeated the words, the examiner informed the participant that “I will ask you to recall those words again at the end of the test.” (Nasreddine, 1995). No points were rewarded for this portion of the test.
Attention
Participants were then subjected to the attention portion of the test. First, the examiner stated, “I am going to say some numbers and when I am through, repeat them to me exactly as I said them.” Then, the examiner stated the numbers 2-1-8-5-4 at a rate of one digit per second. One point was awarded if the sequence was correctly repeated. The participant was then told by the researcher, “Now I am going to say some more numbers, but when I am through you must repeat them to me in the backward order.” (Nasreddine, 1995). The numbers 7-4-2 were read at a rate of one digit per second. One point was awarded if the participant stated 2-4-7.
To further test attentiveness, the examiner instructed the participant, “Now, I will ask you to count by subtracting 7 from 100, and then, keep subtracting 7 from your answer until I tell you to stop.” (Nasreddine, 1995). The subject then performed mental math calculations without the use of fingers or paper/pencil. If the participant asked the researcher questions about where they left off, the researcher responded by repeating the given instructions. 3 points were awarded for four or five correct subtractions, 2 points for two or three correct subtractions, 1 point for one correct subtraction, and no points if the participant did not make any correct subtractions.
Language
Participants were told by the researcher, “I am going to read you a sentence. Repeat it after me, exactly as I say it.” Subjects were instructed to repeat the sentences, “I only know that John is the one to help today,” and, “The cat always hid under the couch when dogs were in the room.” (Nasreddine, 1995). If the participant omitted words, substituted/added words, or made grammatical errors or altering the verb form, no points were awarded. If the sentence was accurately repeated, one point was awarded.
Verbal fluency
The examiner explained to the subjects, “Now, I want you to tell me as many words as you can think of that begin with the letter F. I will tell you to stop after one minute. Proper nouns, numbers, and different forms of a verb are not permitted.” (Nasreddine, 1995). A timer was then set for 60 seconds. If the subject was able to list 11 words or more in the allocated time period, one point was awarded.
Abstraction
The examiner informed the participant, “I will give you two words and I would like you to tell me to what category they belong to: an orange and a banana.” The subject should have responded with, “Fruits,” to which the researcher said, “Yes, both items are part of the category ‘fruits.’” If the participant does not respond with “Fruits,” the examiner will ask for another category and will give no additional instructions or clarifications (Nasreddine, 1995). This was considered the practice trial.
The researcher then said, “Now, a train and a bicycle.” Subsequently, “Now, a ruler and a watch.” (Nasreddine, 1995). If the subject responded with an answer representing transportation, then an answer representing measurement, one point was awarded for each correct response, totaling two points.
Delayed recall
The examiner instructed the participant, “I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember” (Nasreddine, 1995). One point was awarded for each word recalled without cues [Table 3.1].
Memory Index Score
Once the delayed recall trial was completed, the examiner stated category cues if the subject was not able to correctly remember the words. The examiner stated, “I will give you some hints to see if it helps you remember the words, the first word was a body part.” If the participant was still unsuccessful, the examiner provided them with a multiple choice. “Which of the following words do you think it was, ‘nose,’ ‘face,’ ‘shoulder,’ ‘leg,’ or ‘hand?” (Nasreddine, 1995).
Orientation
For the final test, the participant was asked to state the exact date with the year, month, date, and day of the week. They were then asked to state the name of the place of the experiment took place and what city it was in. One point was awarded for each correct prompt answered.
Final score
All of the scores were summed out of a total 30 points. If the participant received a score of 26 or above, their cognitive function was considered normal.
Chronic Stress
Trier Social Stress Test
Two weeks after the first round of experimentation testing chronic stress, participants were invited to the same location to participate in the second part of the experiment focusing on testing for acute stress. The participant met the researcher outside the private study room. The following prompts were taken from the Trier Social Stress Test by Buske-Kirschbaum et al. in 1997.
The experimenter informed the subject, “I, the interviewer, am here to assess how outgoing, gregarious, and comfortable you are in situations in which you must project yourself as an expert. This is a type of personality test for a trait called extraversion. You will be given a hypothetical situation in which you will be applying for your ideal job. In this hypothetical situation, you are applying for your ideal job. You have dreamed about working in this job for as many years as you can remember. You have just seen an advertisement for this perfect job and decided to apply. After submitting your application, you have been invited for an interview. The job pays a very large salary. You are competing against a lot of other candidates, and the final selection will be made based on your ability to convince the interviewers of how your experiences, abilities, and education make you a better candidate that the others. You will try to convince this panel of interviewers that you are the best candidate for the position. In addition, you will be asked to perform a mental math test, which will give us additional information about your working memory capacity. You will have 10 minutes to prepare a detailed speech. After the preparation time has elapsed, you will return and deliver your speech to me, the interviewer. Your speech should explain why you should get the job. Remember, you should try to perform better that all the other participants. These examiners are specially trained to monitor and rate your speech for its believability and convincingness, and they will compare your performance to that of the others who perform this task. Also, you will be videotaped during the task so that the examiners can go over the videotape carefully and rate the contents of your speech as well as your nonverbal behavior. Now let us go back to your room so that you can prepare for your job interview in the given 5 minutes” (Buske-Kirschbaum et al., 1997).
The participant was then given a piece of paper and pen. After 10 minutes had passed, the subject was told to enter the private study room to act as the testing room. However, their notes were confiscated upon entry. The participant was seated with a visible video camera in place. A timer was set for 5 minutes. The experimenter then stated, “Please begin.” The experimenter then took notes on the subject’s performance every one minute. If the subject paused for more than 20 seconds, they were told, “You still have some time. Please continue.” If they asked the researcher a question, they were told, “Do whatever you think is best,” or “Say whatever comes to mind.” After the alarm rang, the experimenter stated, “Please stop, your time is up.” (Buske-Kirschbaum et al., 1997).
The subject was told by the researcher, “Now we would like you to subtract the number 13 from 6233 and keep subtracting 13 from the remainder until we tell you to stop. You should do the subtraction as rapidly but accurately as possible.” A timer was set for 5 minutes. If the subject made an error, they were instructed, “That’s incorrect. Please start again.” If the subject inquired about the starting number or the number they left off, they were only told that the starting number was 6233. After the alarm rang, the experimenter stated, “Please stop, your time is up.” (Buske-Kirschbaum et al., 1997).
Montreal Cognitive Assessment (MoCA) Version 8.2
Once the participant completed the Trier Social Stress Test, they were instructed to take the MoCA Version 8.2. The procedure was identical to the MoCA Version 8.1 the participant took two weeks earlier, apart from changes in the assessment to prevent bias. The following procedures were taken from the MoCA Version 8.2 written by Dr. Ziad Nasreddine [Fig. 3.5, Fig. 3.6, Table 3.2, Table 3.3].
If the participant received a total score of 26 or higher out of 30, their cognitive function was considered normal.
Results
The average age of participants was 15 years of age. There was no positive or negative correlation between age the of the adolescents and the Perceived Stress Scale score [Table 1.1]. However, a regression equation can be modeled, with the standard error of regression being approximately 1.5877 [Fig. 1.4].
The relationship between the PSS score and MoCA delayed memory score (MIS without cue) can be modeled by the equation with a correlation coefficient of approximately 0.5410, indicating a moderate positive correlation [Fig. 1.1]. The relationship between the PSS score and their MIS score can be modeled by the equation with a correlation coefficient of approximately 0.8901, indicating a strong positive correlation between the two variables [Fig. 1.2]. Fig. 1.3 shows the relationship between the PSS score and MoCA score which can be modeled by the quadratic equation with the standard error of regression being approximately 0.7728. The relationship between PSS scores and their MoCA completion time can be modeled by the linear regression equation with a correlation coefficient of -0.8035, indicating a strong negative relationship between the two variables [Fig. 1.5].
During the TSST (Kirschbaum et al., 1993), Subject 1 did not utilize the time allotted to prepare for an interview and seemed extremely agitated throughout the process. After the TSST, they completed the MoCA test 15 seconds faster and improved their MIS by 2 points, but their overall MoCA score remained the same. Subject 2 wrote a full page of notes and displayed characteristics of stressed behavior when the notes were taken away. After the TSST, they completed the MoCA 62 seconds faster, maintained the same MIS score, and improved their MoCA score by 1. Subject 3 wrote a paragraph of notes during the TSST interview portion, thus displaying diverted eye contact and frequent moments of prolonged silence. Throughout the mental math, the participant expressed their stress and annoyance but agreed to continue with the experimentation. They completed the MoCA 94 seconds faster, had a decrease in their MIS by 4 points, and had a decrease in the MoCA score by 4 points. Subject 4 wrote a page of notes for the TSST interview and showed signs of exasperation throughout the interview and mental math sections. They completed the MoCA 100 seconds faster after taking the TSST, had a decrease in their MIS score by 11 and their MoCA score remained the same. Subject 5 wrote two pages of preparation notes and was extremely hesitant to give up the notes. They noted that the experience was extremely stressful and seemed agitated throughout the day. They completed the MoCA 48 seconds faster, had a decrease in MIS score by 1, and a decrease in their MoCA score by 1. This data can be reflected in Figure 2.2.
The compiled data was then compared to the MoCA performance of MS patients with data conducted by Charest et al. in 2020. On the MoCA total score, MS participants without cognitive impairment scored an average of 27.8 (n=75), MS participants with cognitive impairment scored an average of 25.4 (n=23), adolescents tested after the PSS from this experiment scored an average of 28.4 (n=5), and adolescents after the TSST scored an average of 27.4 (n=5). On the visuospatial/executive portion of the MoCA, adolescents after the TSST performed the best with an average of 4.8 out of 5. Adolescents after the PSS and TSST scored the same on attention, scoring an average of 5.8 compared to MS participants without cognitive impairment and with cognitive impairment scoring 5.7 and 5.5 on average respectively. On the verbal fluency portion, adolescents after the TSST scored the best with a 100% pass rate. Adolescents after the PSS showed a 60% pass rate, lower than that of MS participants without cognitive impairment with a 72% pass rate. On delayed memory recall, adolescents after the PSS scored an average of 4.2 out of 5, MS participants without cognitive impairment scored a 4.1, adolescents after the TSST scored a 3.6, and MS participants with cognitive impairment scored a 3.3.
Discussion
The data extracted from this experiment shows that there is little correlation between adolescent age and PSS scores. There was found to be a moderately positive correlation between PSS scores and MoCA delayed memory recall scores, indicating that chronic stress can play a factor in memory ability. This data can be supported by a study done in 2007 by Carmen Sandi which indicates that excessive chronic stress can produce grave effects on memory function (Sandi, 2007). To support this, this data displayed a strong positive correlation between stress and memory which can be supported by a study conducted in 2004 showing that chronic stress is related to memory impairments (Lupien et al., 2004). According to this data, individuals with higher PSS scores completed the MoCA faster, evident by the strong negative correlation. This can be supported by a study in 2013 stating that mental distress can cause faster reaction time as it insinuates stress (D., Apporvagiri, 2013).
After participants completed the TSST, their MoCA scores went down by an average of one point, indicating that acute stress can impair general cognitive function. This is evident by a study conducted in 2016 stating that “stress impaired working memory and cognitive flexibility” (Shields et al., 2016). Participants with low-stress scores as indicated by the PSS improved their MIS after the TSST, which agrees with a study conducted in 2016 indicating that the TSST can improve memory performance (Guez et al, 2016). However, those with moderate to severe stress levels as indicated by the PSS showed a decrease in their MIS after the TSST which contradicts the aforementioned study.
This research also shows that adolescents who underwent the TSST showed MoCA results very similar to MS patients without severe cognitive impairment. This indicates that acute stress can impair cognitive function analogous to MS subjects.
The results from this experiment met the hypothesis that stress could improve reaction time. It was thought that stress would decrease memory function, but the correlation between TSST-induced memory and chronic stress memory is not a linear relationship.
As the sample size of this study consisted of 5 participants, this study can be improved by involving more participants. In addition, it would be beneficial to involve participants from varying locations.
According to a study conducted by the University of California, Los Angeles, up to 60% of students encounter test anxiety. Based on this study, students facing acute stress induced by test-taking can have their cognitive function impaired. A future study could focus on how we can improve the education system to aid students facing test anxiety to prevent their stress from hindering their academic performance.
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Appendix
|
Variable | Participants; n=5 | |
Age (years) | Mean SD | 15 1.41 |
Grade level (US system) | Mean SD | 10.4 1.02 |
PSS Score (0-40) | Mean SD | 26.2 8.18 |
SD = standard deviation, n=number, PSS = Perceived Stress Scale
|
Chronic Stress Data | Subject 1 | Subject 2 | Subject 3 | Subject 4 | Subject 5 |
PSS Score | 13 | 23 | 26 | 32 | 37 |
Age | 13 | 14 | 17 | 16 | 15 |
MoCA Time (min:sec) | 9:23 | 9:09 | 8:35 | 8:52 | 6:55 |
Executive Function /5 | 5 | 5 | 4 | 4 | 5 |
Attention /3 | 3 | 3 | 3 | 3 | 3 |
Mental math /3 | 3 | 2 | 3 | 3 | 3 |
Language Fluency | 0 | 1 | 0 | 1 | 1 |
Abstraction | 1 | 2 | 2 | 2 | 2 |
MIS w/o cue /5 | 4 | 3 | 4 | 5 | 5 |
MIS w/ category clue /5 | 0 | 1 | 1 | 0 | 0 |
MIS w/ multiple choice cue /5 | 0 | 1 | 0 | 0 | 0 |
MIS /15 | 12 | 12 | 14 | 15 | 15 |
MoCA Total Score /30 | 28 | 27 | 27 | 30 | 30 |
Figure 1.1: Relationship between PSS score and MoCA Memory Index Score (MIS) without cue. The x-axis measures PSS scores on a scale of 0 (low stress) to 40 (high stress), the y-axis measures MoCA Memory Index Score without a cue from 0 (no correct) to 5 (all correct).
Figure 1.2: Relationship between the PSS score and MoCA MIS overall. The x-axis measures PSS scores on a scale of 0-40 and the y-axis measures the MoCA overall MIS from 0 (low memory function) to 15 (high memory function).
Figure 1.3: Relationship between PSS score and overall MoCA score. The x-axis measures PSS score and the y-axis measures the Montreal Cognitive Assessment (MoCA) with a score of 26 considered cognitive impairment and score of 26 considered normal (Credit: Nasreddine, 1996).
Figure 1.4: Relationship between PSS score and age. The x-axis measures the PSS score from 0-40 and the y-axis measures the participant’s age in years.
Figure 1.5: Relationship between PSS score and MoCA completion time. The x-axis measures the PSS score from 0-40 and the y-axis measures how long it took for the participant to complete the MoCA (in minutes).
Figure 2.1: Relationship between acute stress and chronic stress on MoCA score. The x-axis displays the participant number, and the y-axis measures the participant’s MoCA score. The blue bar shows the participant’s MoCA score due to chronic stress while the red bar shows the participant’s MoCA score after the TSST (Kirschbaum et al., 1993), inducing acute stress.SST.
Figure 2.2: Relationship between acute stress and chronic stress on MIS. The x-axis displays the participant number, and the y-axis measures the participant’s MoCA score. The blue bar shows the participant’s MIS due to chronic stress and the red bar shows the participant’s MIS as a result of acute stress.
Table 2.1: Participant Experimental Data – Acute Stress
Acute Stress Data | Subject 1 | Subject 2 | Subject 3 | Subject 4 | Subject 5 |
MoCA Ver 8.2 Completion Time (min:sec) | 8:20 | 8:08 | 7:35 | 7:12 | 6:07 |
Executive Function /5 | 5 | 5 | 4 | 5 | 5 |
Attention /3 | 3 | 3 | 3 | 3 | 3 |
Mental math /3 | 2 | 3 | 3 | 3 | 3 |
Language Fluency | 1 | 1 | 1 | 1 | 1 |
Abstraction | 1 | 2 | 2 | 2 | 2 |
MIS w/o cue /5 | 4 | 4 | 3 | 3 | 4 |
MIS w/ category clue /5 | 1 | 0 | 0 | 0 | 1 |
MIS w/ multiple choice cue /5 | 0 | 1 | 2 | 2 | 0 |
MIS /15 | 14 | 13 | 11 | 11 | 14 |
MoCA Total Score /30 | 28 | 27 | 26 | 27 | 29 |
Figure 3.1: MoCA Version 8.1 visuospatial/executive test. This displays the visuospatial/executive cognitive function portion of the Montreal Cognitive Assessment.
Credit: Dr. Ziad Nasreddine
Figure 3.2: MoCA version 8.1 naming test. This displays the naming cognitive function portion of the Montreal Cognitive Assessment version 8.1.
Credit: Dr. Ziad Nasreddine
Table 3.1: MoCA version 8.1 Memory Index
Target Word | Category Cue | Multiple Choice Cue | ||||
Face | Body part | Nose, face, hand, shoulder, leg | ||||
Velvet | Type of fabric | Denim, velvet, cotton, nylon, silk | ||||
Church | Type of building | Church, school, hospital, library, store | ||||
Daisy | Type of flower | Rose, daisy, tulip, lily, daffodil | ||||
Red | Color | Red, blue, green, yellow, purple | ||||
Memory Index Score (MIS) Scoring | Total | |||||
Number of words recalled without cue | # | Multiplied by 3 | Score | |||
Number of words recalled with a category cue | # | Multiplied by 2 | Score | |||
Number of words recalled with a multiple choice cue | # | Multiplied by 1 | Score | |||
| Total MIS (all points added) | --/15 | ||||
Credit: Dr. Ziad Nasreddine
Figure 3.3: Location of experimentation. This image shows the location of all elements of experimentation at the Palos Verdes Library District.
Credit: Palos Verdes Library District
Figure 3.4: Diagram of the experimentation set-up.
Figure 3.5: MoCA Version 8.2 visuospatial/executive test. This displays the visuospatial/executive cognitive function portion of the Montreal Cognitive Assessment.
Credit: Dr. Ziad Nasreddine
Figure 3.6: MoCA version 8.2 naming test. This displays the naming cognitive function portion of the Montreal Cognitive Assessment version 8.2.
Credit: Dr. Ziad NAsreddine
Table 3.2: MoCA Version 8.2 Abstraction
Words | Correct Association | Incorrect Association |
Bed, table | Furniture, pieces of furniture, furnishing | Flat, four legs, bedroom, made from wood |
Letter, telephone | Communication, forms of communication, means of corresponding | Alphabet, letters, numbers, news, messages |
Credit: Dr. Ziad Nasreddine
Table 3.3: MoCA Version 8.2 Memory Index
Target Word | Category Cue | Multiple Choice Cue | ||||
Hand | Body part | Nose, face, hand, shoulder, leg | ||||
Nylon | Type of fabric | Denim, velvet, cotton, nylon, silk | ||||
Park | Public place | Church, school, hospital, library, park | ||||
Carrot | Type of food | Tomato, carrot, lettuce, cucumber, celery | ||||
Yellow | Color | Red, blue, green, yellow, purple | ||||
Memory Index Score (MIS) Scoring | Total | |||||
Number of words recalled without cue | # | Multiplied by 3 | Score | |||
Number of words recalled with a category cue | # | Multiplied by 2 | Score | |||
Number of words recalled with a multiple choice cue | # | Multiplied by 1 | Score | |||
| Total MIS (all points added) | --/15 | ||||
Credit: Dr. Ziad Nasreddine
Table 4.1: Mean MoCA Results
| MS participants without cognitive impairment (n=75) | MS participants with cognitive impairment (n=23) | Adolescents after PSS score – chronic stress (n=5) | Adolescents after TSST – acute stress (n=5) |
MoCA total score |
|
|
|
|
Mean SD | 27.8 1.7 | 25.4 2.2 | 28.4 1.4 | 27.4 1.0 |
Visuospatial/executive |
|
|
|
|
Mean SD | 4.4 0.7 | 3.61.2 | 4.6 0.5 | 4.8 0.4 |
Attention |
|
|
|
|
Mean SD | 5.7 0.5 | 5.5 0.9 | 5.8 0.4 | 5.8 0.4 |
Verbal fluency |
|
|
|
|
% <11 words (failure) | 28.0% | 69.6% | 40.0% | 0% |
Number of words |
|
|
|
|
Mean SD | 12.4 3.5 | 8.8 3.6 | 10.6 1.9 | 13.0 1.4 |
Abstraction |
|
|
|
|
Mean SD | 1.8 0.4 | 1.7 0.4 | 1.8 0.4 | 1.8 0.4 |
Delayed memory recall |
|
|
|
|
Mean SD | 4.1 1.0 | 3.3 1.1 | 4.2 0.7 | 3.6 0.5 |
Source: Kim Charest, Alexandra Tremblay, Roxane Langlois, Élaine Roger, Pierre Duquette, Isabelle Rouleau
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