{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:10:55Z","timestamp":1784128255580,"version":"3.55.0"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Alterations in hypothalamic-pituitary-adrenal axis activity have been implicated in cognitive aging, yet large, racially diverse studies using physiologically active salivary cortisol studies are limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether diurnal salivary cortisol indices are associated with cognitive outcomes, including incident Alzheimer disease (AD), and whether distributions and associations differ by race.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This prospective cohort study was conducted from 2000 to 2011, with 11 years of follow-up, as part of the Chicago Health and Aging Project, a community-based study of older adults in urban Chicago. Participants provided salivary cortisol samples across a day (waking, afternoon, and bedtime) and completed cognitive assessments. Analyses were conducted from June to October 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Five salivary cortisol indices capturing intraday variability (coefficient of variation [CV]), cumulative exposure (mean cortisol and area under the curve with respect to ground [AUCg]), and diurnal change (diurnal slope and AUC with respect to increase [AUCi]).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Outcomes of interest were global cognition, cognitive decline, and incident AD, adjusted for demographic, health, and behavioral factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 3895 participants (mean [SD] age, 76.7 [6.8] years; 2509 [64.4%] women; 2503 Black participants [64.3%] and 1392 White participants [35.7%]), all cortisol indices were cross-sectionally associated with cognitive performance. Longitudinally, compared with the first quintile (Q1), medium to high cortisol intraday variability (CV) was associated with slower decline (Q3: \u03b2\u2009=\u20090.02 [95% CI, 0.001 to 0.04];\n P<\/jats:italic>\n \u2009=\u2009.04; Q4: \u03b2\u2009=\u20090.03 [95% CI, 0.01 to 0.04];\n P<\/jats:italic>\n \u2009=\u2009.003), whereas the highest cumulative exposure was associated with faster decline (mean cortisol Q5: \u03b2\u2009=\u2009\u22120.02 [95% CI, \u22120.04 to \u22120.004];\n P<\/jats:italic>\n \u2009=\u2009.02; AUCg Q5: \u03b2\u2009=\u2009\u22120.02 [95% CI, \u22120.03 to 0.00];\n P<\/jats:italic>\n \u2009=\u2009.046). Diurnal change indices (slope, AUCi) were not associated with decline or incident AD. Black participants exhibited lower cortisol exposure but flatter slopes and lower intraday variability, reflecting a blunted diurnal rhythm; associations with decline were similar across races.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of Black and White older adults, altered diurnal cortisol patterning was associated with faster cognitive decline but not short-term AD risk. These findings support salivary cortisol as a potential early biomarker of neurocognitive aging. Racial differences in cortisol patterning suggest differential biological embedding of stress, consistent with structural inequities.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.22955","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:00:31Z","timestamp":1784127631000},"page":"e2622955","source":"Crossref","is-referenced-by-count":0,"title":["Salivary Cortisol and Cognitive Decline and Alzheimer Disease in Older Adults"],"prefix":"10.1001","volume":"9","author":[{"given":"Ted K. 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