Salivary cortisol awakening response in mild Alzheimer disease, caregivers, and noncaregivers

Helané Wahbeh, Shirley S. Kishiyama, Daniel Zajdel, Barry S. Oken

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


Alterations in the hypothalamic-pituitary-adrenal axis have been noted in people with Alzheimer disease (AD) and in the people caring for them. In a case-control study, we assessed whether the cortisol response at awakening and diurnal cortisol would reflect these changes. AD patients, their caregivers, and healthy senior noncaregivers collected saliva within 5 minutes of waking, 30 minutes after waking, before lunch, 1 hour after lunch, and at 11 pm or when getting ready for bed. They also completed a Perceived Stress Scale. Total cortisol for the day after adjusting for antidepressant use revealed a group effect [F(2,39) = 12.49, P < 0.0001], with mild AD patients and caregivers having higher cortisol values. Unlike the noncaregivers (t = -1.15, df = 14, P > 0.27), both cortisol values of the AD caregivers (t = -2.96, df = 16, P < 0.03) and the AD patients' (t = -2.5, df=14, P<0.01) increased between awakening and 30 minutes afterward. There were also group differences at awakening [F(2,48) = 4.6, P = 0.012] adjusting for antidepressant use and 30 minutes after waking adjusting for antidepressant use and awakening cortisol [F(2,46) = 4.7, P = 0.014 < 0.02). AD patients (r = 0.45, P = 0.08) and caregivers (r = 0.44, P = 0.10) with higher cortisol values 30 minutes after waking also showed a trend toward higher perceived stress scores. Salivary cortisol and cortisol response on awakening may enhance future studies relating free cortisol to subjective psychologic and physiologic markers.

Original languageEnglish (US)
Pages (from-to)181-183
Number of pages3
JournalAlzheimer Disease and Associated Disorders
Issue number2
StatePublished - Apr 2008


  • Alzheimer disease
  • Awakening cortisol
  • Stress

ASJC Scopus subject areas

  • Clinical Psychology
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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