Despite the extensive knowledge about the effects of chronic stress on cognition, the underlying mechanisms remain unclear. We conducted a cross-sectional moderation analysis on a population-based sample of 596 adults to examine the age- and sex-specific role of emotion regulation (ER) in the relationship between chronic stress and cognitive performance using validated self-report questionnaires. While women showed no direct or moderated relationship between stress and cognition, men displayed a distinct age-related pattern where stress was negatively associated with poorer cognitive performance at older ages, and the onset of this relationship was detected earlier in men with ER problems. These results showed that suppression of emotions and lack of executive control of ER amplify the negative consequences of chronic stress and suggest that there are sex-specific differences in the decline of ability to cope with long-term exposure to stressors.

Department of Neurology Gloucestershire Hospitals NHS Foundation Trust Gloucester UK

Faculty of Medicine University of Maribor Maribor Slovenia

Institute of Molecular and Translational Medicine Faculty of Medicine and Dentistry Palacký University Olomouc Hněvotínská 1333 5 779 00 Olomouc Czech Republic

Translational Neuroscience and Aging Program Center for Translational Medicine International Clinical Research Centre St Anne's University Hospital Brno Czech Republic

Zobrazit více v PubMed

Limone P, Toto GA, Messina G. Impact of the COVID-19 pandemic and the Russia-Ukraine war on stress and anxiety in students: A systematic review. Front. Psychiatry. 2022;13:1081013. doi: 10.3389/fpsyt.2022.1081013. PubMed DOI PMC

Weierstall-Pust R, et al. Stressors related to the Covid-19 pandemic, climate change, and the Ukraine crisis, and their impact on stress symptoms in Germany: Analysis of cross-sectional survey data. BMC Public Health. 2022;22:2233. doi: 10.1186/s12889-022-14682-9. PubMed DOI PMC

Mottola F, Gnisci A, Kalaitzaki A, Vintilă M, Sergi I. The impact of the Russian-Ukrainian war on the mental health of Italian people after 2 years of the pandemic: Risk and protective factors as moderators. Front. Psychol. 2023;14:1154502. doi: 10.3389/fpsyg.2023.1154502. PubMed DOI PMC

Chrousos GP, Gold PW. The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis. JAMA. 1992;267:1244–1252. doi: 10.1001/jama.1992.03480090092034. PubMed DOI

Ross RA, Foster SL, Ionescu DF. The role of chronic stress in anxious depression. Chronic Stress. 2017;1:247054701668947. doi: 10.1177/2470547016689472. PubMed DOI PMC

Tafet GE, Nemeroff CB. The links between stress and depression: Psychoneuroendocrinological, genetic, and environmental interactions. J. Neuropsychiatry Clin. Neurosci. 2016;28:77–88. doi: 10.1176/appi.neuropsych.15030053. PubMed DOI

Grossi G, Perski A, Osika W, Savic I. Stress-related exhaustion disorder: Clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout. Scand. J. Psychol. 2015;56:626–636. doi: 10.1111/sjop.12251. PubMed DOI

Schwabe L, Joëls M, Roozendaal B, Wolf OT, Oitzl MS. Stress effects on memory: An update and integration. Neurosci. Biobehav. Rev. 2012;36:1740–1749. doi: 10.1016/j.neubiorev.2011.07.002. PubMed DOI

Sandi C. Stress and cognition. WIREs Cogn. Sci. 2013;4:245–261. doi: 10.1002/wcs.1222. PubMed DOI

Herman, J. P. et al. Regulation of the Hypothalamic‐Pituitary‐Adrenocortical Stress Response. in Comprehensive Physiology 603–621 (Wiley, 2016). 10.1002/cphy.c150015. PubMed PMC

Ziegler, M. G. Psychological Stress and the Autonomic Nervous System. in Primer on the Autonomic Nervous System 291–293 (Elsevier, 2012). 10.1016/B978-0-12-386525-0.00061-5.

Eiden, L. E. Neuropeptide–Catecholamine Interactions in Stress. 399–404 (2013). 10.1016/B978-0-12-411512-5.00018-X. PubMed PMC

Maes M, et al. The effects of psychological stress on humans: Increased production of pro-inflammatory cytokines and Th1-like response in stress-induced anxiety. Cytokine. 1998;10:313–318. doi: 10.1006/cyto.1997.0290. PubMed DOI

Lucassen PJ, et al. Neuropathology of stress. Acta Neuropathol. 2014;127:109–135. doi: 10.1007/s00401-013-1223-5. PubMed DOI PMC

Blix E, Perski A, Berglund H, Savic I. Long-term occupational stress is associated with regional reductions in brain tissue volumes. PLoS One. 2013;8:e64065. doi: 10.1371/journal.pone.0064065. PubMed DOI PMC

Yang L, et al. The effects of psychological stress on depression. Curr. Neuropharmacol. 2015;13:494–504. doi: 10.2174/1570159X1304150831150507. PubMed DOI PMC

Maslach C, Schaufeli WB, Leiter MP. Job Burnout. Annu. Rev. Psychol. 2001;52:397–422. doi: 10.1146/annurev.psych.52.1.397. PubMed DOI

Het S, Ramlow G, Wolf OT. A meta-analytic review of the effects of acute cortisol administration on human memory. Psychoneuroendocrinology. 2005;30:771–784. doi: 10.1016/j.psyneuen.2005.03.005. PubMed DOI

Wolf OT. Stress and memory retrieval: Mechanisms and consequences. Curr. Opin. Behav. Sci. 2017;14:40–46. doi: 10.1016/j.cobeha.2016.12.001. DOI

Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat. Rev. Neurosci. 2009;10:434–445. doi: 10.1038/nrn2639. PubMed DOI

Liu Q, et al. Impact of chronic stress on attention control: Evidence from behavioral and event-related potential analyses. Neurosci. Bull. 2020;36:1395–1410. doi: 10.1007/s12264-020-00549-9. PubMed DOI PMC

Gagnon SA, Wagner AD. Acute stress and episodic memory retrieval: Neurobiological mechanisms and behavioral consequences. Ann. N. Y. Acad. Sci. 2016;1369:55–75. doi: 10.1111/nyas.12996. PubMed DOI

Bremner JD. Traumatic stress: Effects on the brain. Dialogues Clin. Neurosci. 2006;8:445–461. doi: 10.31887/DCNS.2006.8.4/jbremner. PubMed DOI PMC

Thompson RA. Emotion regulation: A theme in search of definition. Monogr. Soc. Res. Child Dev. 1994;59:25. doi: 10.1111/j.1540-5834.1994.tb01276.x. PubMed DOI

Gyurak A, Gross JJ, Etkin A. Explicit and implicit emotion regulation: A dual-process framework. Cogn. Emot. 2011;25:400–412. doi: 10.1080/02699931.2010.544160. PubMed DOI PMC

Sheppes G, Suri G, Gross JJ. Emotion regulation and psychopathology. Annu. Rev. Clin. Psychol. 2015;11:379–405. doi: 10.1146/annurev-clinpsy-032814-112739. PubMed DOI

Augustine AA, Hemenover SH. On the relative effectiveness of affect regulation strategies: A meta-analysis. Cogn. Emot. 2009;23:1181–1220. doi: 10.1080/02699930802396556. DOI

Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin. Psychol. Rev. 2010;30:217–237. doi: 10.1016/j.cpr.2009.11.004. PubMed DOI

Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J. Psychopathol. Behav. Assess. 2004;26:41–54. doi: 10.1023/B:JOBA.0000007455.08539.94. DOI

Wang M, Saudino KJ. Emotion regulation and stress. J. Adult Dev. 2011;18:95–103. doi: 10.1007/s10804-010-9114-7. DOI

Oei NYL, et al. Glucocorticoids decrease hippocampal and prefrontal activation during declarative memory retrieval in young men. Brain Imaging Behav. 2007;1:31–41. doi: 10.1007/s11682-007-9003-2. PubMed DOI PMC

Jentsch VL, Merz CJ, Wolf OT. Restoring emotional stability: Cortisol effects on the neural network of cognitive emotion regulation. Behav. Brain Res. 2019;374:111880. doi: 10.1016/j.bbr.2019.03.049. PubMed DOI

Langer K, et al. Acute stress improves the effectivity of cognitive emotion regulation in men. Sci. Rep. 2020;10:11571. doi: 10.1038/s41598-020-68137-5. PubMed DOI PMC

Lazarus RS, Folkman S. Stress, Appraisal, and Coping. Springer; 1984.

Nichols E, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the Global Burden of Disease Study 2019. Lancet Public Heal. 2022;7:e105–e125. doi: 10.1016/S2468-2667(21)00249-8. PubMed DOI PMC

Compas BE, et al. Coping and emotion regulation from childhood to early adulthood: Points of convergence and divergence. Aust. J. Psychol. 2014;66:71–81. doi: 10.1111/ajpy.12043. PubMed DOI PMC

Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behav. Res. Ther. 2010;48:974–983. doi: 10.1016/j.brat.2010.06.002. PubMed DOI

Gross JJ. Emotion regulation: Taking stock and moving forward. Emotion. 2013;13:359–365. doi: 10.1037/a0032135. PubMed DOI

Skinner EA, Zimmer-Gembeck MJ. The development of coping. Annu. Rev. Psychol. 2007;58:119–144. doi: 10.1146/annurev.psych.58.110405.085705. PubMed DOI

Gross JJ, Thompson RA. Emotion Regulation: Conceptual Foundations. In: Gross JJ, editor. Handbook of Emotion Regulation. UK: The Guilford Press; 2007. pp. 3–24.

Phelps EA. Emotion and cognition: Insights from studies of the human amygdala. Annu. Rev. Psychol. 2006;57:27–53. doi: 10.1146/annurev.psych.56.091103.070234. PubMed DOI

Ochsner KN, Gross JJ. The cognitive control of emotion. Trends Cogn. Sci. 2005;9:242–249. doi: 10.1016/j.tics.2005.03.010. PubMed DOI

Miklósi M, Martos T, Szabó M, Kocsis-Bogár K, Forintos D. Cognitive emotion regulation and stress: A multiple mediation approach. Transl. Neurosci. 2014;5:64. doi: 10.2478/s13380-014-0207-9. DOI

Goodman RN, Rietschel JC, Lo L-C, Costanzo ME, Hatfield BD. Stress, emotion regulation and cognitive performance: The predictive contributions of trait and state relative frontal EEG alpha asymmetry. Int. J. Psychophysiol. 2013;87:115–123. doi: 10.1016/j.ijpsycho.2012.09.008. PubMed DOI

Kalia V, Knauft K. Emotion regulation strategies modulate the effect of adverse childhood experiences on perceived chronic stress with implications for cognitive flexibility. PLoS One. 2020;15:e0235412. doi: 10.1371/journal.pone.0235412. PubMed DOI PMC

Graves BS, Hall ME, Dias-Karch C, Haischer MH, Apter C. Gender differences in perceived stress and coping among college students. PLoS One. 2021;16:e0255634. doi: 10.1371/journal.pone.0255634. PubMed DOI PMC

Dyson R, Renk K. Freshmen adaptation to university life: Depressive symptoms, stress, and coping. J. Clin. Psychol. 2006;62:1231–1244. doi: 10.1002/jclp.20295. PubMed DOI

Howerton A, Van Gundy K. Sex differences in coping styles and implications for depressed mood. Int. J. Stress Manag. 2009;16:333–350. doi: 10.1037/a0016843. DOI

Moret-Tatay C, Beneyto-Arrojo MJ, Laborde-Bois SC, Martínez-Rubio D, Senent-Capuz N. Gender, coping, and mental health: A Bayesian network model analysis. Soc. Behav. Personal. Int. J. 2016;44:827–835. doi: 10.2224/sbp.2016.44.5.827. DOI

Matud MP. Gender differences in stress and coping styles. Pers. Individ. Dif. 2004;37:1401–1415. doi: 10.1016/j.paid.2004.01.010. DOI

Nolen-Hoeksema S, Aldao A. Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms. Pers. Individ. Dif. 2011;51:704–708. doi: 10.1016/j.paid.2011.06.012. DOI

McRae K, Ochsner KN, Mauss IB, Gabrieli JJD, Gross JJ. Gender differences in emotion regulation: An fMRI study of cognitive reappraisal. Gr. Process. Intergr. Relat. 2008;11:143–162. doi: 10.1177/1368430207088035. PubMed DOI PMC

Goubet KE, Chrysikou EG. Emotion regulation flexibility: Gender differences in context sensitivity and repertoire. Front. Psychol. 2019;10:935. doi: 10.3389/fpsyg.2019.00935. PubMed DOI PMC

Zaninotto P, Batty GD, Allerhand M, Deary IJ. Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the English Longitudinal Study of Ageing. J. Epidemiol. Community Health. 2018;72:685–694. doi: 10.1136/jech-2017-210116. PubMed DOI PMC

Caselli RJ, et al. Neuropsychological decline up to 20 years before incident mild cognitive impairment. Alzheimer’s Dement. 2020;16:512–523. doi: 10.1016/j.jalz.2019.09.085. PubMed DOI PMC

Rabbitt PMA, et al. The University of manchester longitudinal study of cognition in normal healthy old age, 1983 through 2003. Aging Neuropsychol. Cogn. 2004;11:245–279. doi: 10.1080/13825580490511116. DOI

Blanchard-Fields F, Stein R, Watson TL. Age differences in emotion-regulation strategies in handling everyday problems. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 2004;59:P261–P269. PubMed

Isaacowitz DM. What do we know about aging and emotion regulation? Perspect. Psychol. Sci. 2022;17:1541–1555. doi: 10.1177/17456916211059819. PubMed DOI PMC

Isaacowitz DM, Livingstone KM, Castro VL. Aging and emotions: Experience, regulation, and perception. Curr. Opin. Psychol. 2017;17:79–83. doi: 10.1016/j.copsyc.2017.06.013. PubMed DOI PMC

Urry HL, Gross JJ. Emotion regulation in older age. Curr. Dir. Psychol. Sci. 2010;19:352–357. doi: 10.1177/0963721410388395. DOI

Murman D. The impact of age on cognition. Semin. Hear. 2015;36:111–121. doi: 10.1055/s-0035-1555115. PubMed DOI PMC

Novotný JS, et al. Natural pattern of cognitive aging. J. Alzheimer’s Dis. 2022;88:1147–1155. doi: 10.3233/JAD-220312. PubMed DOI

Keys BBA, White DDA. Exploring the relationship between age, executive abilities, and psychomotor speed. J. Int. Neuropsychol. Soc. 2000;6:76–82. doi: 10.1017/S1355617700611098. PubMed DOI

Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin. Geriatr. Med. 2013;29:737–752. doi: 10.1016/j.cger.2013.07.002. PubMed DOI PMC

Trouillet R, Doan-Van-Hay L-M, Launay M, Martin S. Impact of age, and cognitive and coping resources on coping. Can. J. Aging. 2011;30:541–550. doi: 10.1017/S0714980811000456. PubMed DOI

Li G, Li K. Turning point of cognitive decline for Chinese older adults from a longitudinal analysis: Protective factors and risk factors. Healthcare. 2022;10:2304. doi: 10.3390/healthcare10112304. PubMed DOI PMC

van der Willik KD, et al. Trajectories of cognitive and motor function between ages 45 and 90 years: A population-based study. J. Gerontol. Ser. A. 2021;76:297–306. doi: 10.1093/gerona/glaa187. PubMed DOI PMC

Romero-Martínez Á, Hidalgo-Moreno G, Moya-Albiol L. Neuropsychological consequences of chronic stress: The case of informal caregivers. Aging Ment. Health. 2020;24:259–271. doi: 10.1080/13607863.2018.1537360. PubMed DOI

Öhman L, Nordin S, Bergdahl J, Slunga Birgander L, Stigsdotter Neely A. Cognitive function in outpatients with perceived chronic stress. Scand. J. Work Environ. Health. 2007;33:223–232. doi: 10.5271/sjweh.1131. PubMed DOI

Saslow LR, et al. Speaking under pressure: Low linguistic complexity is linked to high physiological and emotional stress reactivity. Psychophysiology. 2014;51:257–266. doi: 10.1111/psyp.12171. PubMed DOI PMC

Turner AD, James BD, Capuano AW, Aggarwal NT, Barnes LL. Perceived stress and cognitive decline in different cognitive domains in a cohort of older African Americans. Am. J. Geriatr. Psychiatry. 2017;25:25–34. doi: 10.1016/j.jagp.2016.10.003. PubMed DOI PMC

Charles ST, Luong G. Emotional experience across adulthood. Curr. Dir. Psychol. Sci. 2013;22:443–448. doi: 10.1177/0963721413497013. DOI

Charles ST, Leger KA, Urban EJ. Emotional experience and health: What we know, and where to go from here. In: Ong AA, Löckenhoff CE, editors. Emotion, Aging, and Health. American Psychological Association; 2016. pp. 185–204.

Endler NS. Stress, anxiety and coping: The multidimensional interaction model. Can. Psychol. Psychol. Can. 1997;38:136–153. doi: 10.1037/0708-5591.38.3.136. DOI

Baumeister RF, Vohs KD, Tice DM. The strength model of self-control. Curr. Dir. Psychol. Sci. 2007;16:351–355. doi: 10.1111/j.1467-8721.2007.00534.x. DOI

Richards JM. The cognitive consequences of concealing feelings. Curr. Dir. Psychol. Sci. 2004;13:131–134. doi: 10.1111/j.0963-7214.2004.00291.x. DOI

Bailen NH, Koval P, Strube M, Haslam N, Thompson RJ. Negative emotion and nonacceptance of emotion in daily life. Emotion. 2022;22:992–1003. doi: 10.1037/emo0000898. PubMed DOI

Campbell-Sills L, Barlow DH, Brown TA, Hofmann SG. Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behav. Res. Ther. 2006;44:1251–1263. doi: 10.1016/j.brat.2005.10.001. PubMed DOI

Cărnuţă M, Crişan LG, Vulturar R, Opre A, Miu AC. Emotional non-acceptance links early life stress and blunted cortisol reactivity to social threat. Psychoneuroendocrinology. 2015;51:176–187. doi: 10.1016/j.psyneuen.2014.09.026. PubMed DOI

Gross JJ. Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology. 2002;39:S0048577201393198. doi: 10.1017/S0048577201393198. PubMed DOI

Goldfarb EV, Seo D, Sinha R. Sex differences in neural stress responses and correlation with subjective stress and stress regulation. Neurobiol. Stress. 2019;11:100177. doi: 10.1016/j.ynstr.2019.100177. PubMed DOI PMC

Koch K, et al. Gender differences in the cognitive control of emotion: An fMRI study. Neuropsychologia. 2007;45:2744–2754. doi: 10.1016/j.neuropsychologia.2007.04.012. PubMed DOI

Domes G, et al. The neural correlates of sex differences in emotional reactivity and emotion regulation. Hum. Brain Mapp. 2009;31:758–769. doi: 10.1002/hbm.20903. PubMed DOI PMC

Raio CM, Orederu TA, Palazzolo L, Shurick AA, Phelps EA. Cognitive emotion regulation fails the stress test. Proc. Natl. Acad. Sci. 2013;110:15139–15144. doi: 10.1073/pnas.1305706110. PubMed DOI PMC

McEwen BS, Morrison JH. The brain on stress: Vulnerability and plasticity of the prefrontal cortex over the life course. Neuron. 2013;79:16–29. doi: 10.1016/j.neuron.2013.06.028. PubMed DOI PMC

Peter RH. Synaptic density in human frontal cortex: Developmental changes and effects of aging. Brain Res. 1979;163:195–205. doi: 10.1016/0006-8993(79)90349-4. PubMed DOI

Raz N, et al. Regional brain changes in aging healthy adults: General trends, individual differences and modifiers. Cereb. Cortex. 2005;15:1676–1689. doi: 10.1093/cercor/bhi044. PubMed DOI

Raz N, et al. Aging, sexual dimorphism, and hemispheric asymmetry of the cerebral cortex: Replicability of regional differences in volume. Neurobiol. Aging. 2004;25:377–396. doi: 10.1016/S0197-4580(03)00118-0. PubMed DOI

Sotoudeh N, Namavar MR, Zarifkar A, Heidarzadegan AR. Age-dependent changes in the medial prefrontal cortex and medial amygdala structure, and elevated plus-maze performance in the healthy male Wistar rats. IBRO Rep. 2020;9:183–194. doi: 10.1016/j.ibror.2020.08.002. PubMed DOI PMC

Renna ME. A review and novel theoretical model of how negative emotions influence inflammation: The critical role of emotion regulation. Brain Behav. Immun. Heal. 2021;18:100397. doi: 10.1016/j.bbih.2021.100397. PubMed DOI PMC

Ospina LH, et al. Inflammation and emotion regulation: Findings from the MIDUS II study. Brain Behav. Immun. Heal. 2022;26:100536. doi: 10.1016/j.bbih.2022.100536. PubMed DOI PMC

Lopez RB, et al. emotion regulation and immune functioning during grief: Testing the role of expressive suppression and cognitive reappraisal in inflammation among recently bereaved spouses. Psychosom. Med. 2020;82:2–9. doi: 10.1097/PSY.0000000000000755. PubMed DOI

Haroon E, Raison CL, Miller AH. Psychoneuroimmunology meets neuropsychopharmacology: Translational implications of the impact of inflammation on behavior. Neuropsychopharmacology. 2012;37:137–162. doi: 10.1038/npp.2011.205. PubMed DOI PMC

Movsisyan NK, et al. Kardiovize Brno 2030, a prospective cardiovascular health study in Central Europe: Methods, baseline findings and future directions. Eur. J. Prev. Cardiol. 2018;25:54–64. doi: 10.1177/2047487317726623. PubMed DOI

Hartshorne JK, Germine LT. When does cognitive functioning peak? The asynchronous rise and fall of different cognitive abilities across the life span. Psychol. Sci. 2015;26:433–443. doi: 10.1177/0956797614567339. PubMed DOI PMC

Hughes ML, Agrigoroaei S, Jeon M, Bruzzese M, Lachman ME. Change in cognitive performance from midlife into old age: Findings from the midlife in the United States (MIDUS) study. J. Int. Neuropsychol. Soc. 2018;24:805–820. doi: 10.1017/S1355617718000425. PubMed DOI PMC

Lachman ME, Teshale S, Agrigoroaei S. Midlife as a pivotal period in the life course. Int. J. Behav. Dev. 2015;39:20–31. doi: 10.1177/0165025414533223. PubMed DOI PMC

Almeida DM, et al. Charting adult development through (historically changing) daily stress processes. Am. Psychol. 2020;75:511–524. doi: 10.1037/amp0000597. PubMed DOI PMC

Gross JJ, et al. Emotion and aging: Experience, expression, and control. Psychol. Aging. 1997;12:590–599. doi: 10.1037/0882-7974.12.4.590. PubMed DOI

Cohen S, Williamson GM. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The Claremont Symposium on Applied Social Psychology. The Social Psychology of Health. Sage Publications Inc; 1988. pp. 31–67.

Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs. Res. 2012;6:121–127. doi: 10.1016/j.anr.2012.08.004. PubMed DOI

Nasreddine ZS, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 2005;53:695–699. doi: 10.1111/j.1532-5415.2005.53221.x. PubMed DOI

Julayanont P, Brousseau M, Chertkow H, Phillips N, Nasreddine ZS. Montreal cognitive assessment memory index score (MoCA-MIS) as a predictor of conversion from mild cognitive impairment to Alzheimer’s disease. J. Am. Geriatr. Soc. 2014;62:679–684. doi: 10.1111/jgs.12742. PubMed DOI

Victor SE, Klonsky ED. Validation of a brief version of the difficulties in emotion regulation scale (DERS-18) in five samples. J. Psychopathol. Behav. Assess. 2016;38:582–589. doi: 10.1007/s10862-016-9547-9. PubMed DOI PMC