01/15/2026
By Hajnalka Hartl

The Zuckerberg College of Health Sciences, Department of Public Health, invites you to attend the doctoral dissertation defense of Hajnalka Hartl on "Perceived stress, systemic inflammation, anti-inflammatory medication use and cognitive function in U.S. Mainland older Puerto Rican adults."

Candidate Name: Hajnalka E. Hartl
Degree: Sc.D. in Epidemiology
Defense Date: Wednesday, Jan. 28, 2026
Time: 11 a.m. to noon
Location: Room 309, McGauvran Center, South Campus

Title: "Perceived stress, systemic inflammation, anti-inflammatory medication use and cognitive function in U.S. Mainland older Puerto Rican adults."

Dissertation Committee:

  • Natalia Palacios, Ph.D., (Chair and advisor), Associate Professor, Department of Public Health, UMass Lowell
  • Katherine Tucker, Ph.D., Professor Emeritus, Biomedical and Nutritional Sciences, UMass Lowell
  • Jong Soo Lee, Ph.D., Associate Professor, Department of Mathematics & Statistics, UMass Lowell

Brief Abstract:
The leading cause of cognitive impairment in the United States is Alzheimer’s disease. Mainland Puerto Ricans have high prevalence of chronic diseases, such as type 2 diabetes (T2D), hypertension and obesity, and are at a higher risk of Alzheimer’s disease compared to other Latinos residing in the US. High levels of psychological stress have been linked to diminished cognitive function. Mainland U. S. Puerto Ricans experience higher psychosocial stress compared to other ethnic groups of Hispanic/Latino heritage living in the United States. Systemic inflammation has also been previously associated with cognitive decline. Furthermore, there is some evidence that older adults who use non-steroidal anti-inflammatory drugs (NSAIDs) may have better cognitive outcomes, or slower cognitive decline over time. To our knowledge, cognitive function in the matrix of stress and inflammation has not been evaluated among Boston Puerto Rican older adults.
The overarching goal of this dissertation is to evaluate if perceived stress and systemic inflammation are associated with cognitive decline, and if NSAID use among Boston Puerto Rican Health Study participants is associated with better cognitive outcomes.

We investigated the relationship of perceived stress and cognition at baseline and over ~12 years of follow-up, we have evaluated inflammatory markers as well as the use of anti-inflammatory medication to examine if there is an association with cognition and the trajectory of cognitive function. We analyzed data from the Boston Puerto Rican Health Study using biological and anthropomorphic measurements as well as data from questionnaires from ~1500 Puerto Rican adults aged 45-75 years (at baseline).

The first aim shows that at baseline and over 12 years of follow-up higher perceived stress is associated with lower Global Cognition Score (GCS). The second aim demonstrates that over 12 years of follow-up higher interleukin-6 (IL-6) levels and to a lesser extent higher serum c-reactive protein (CRP) levels are associated with worse cognitive trajectory. Although many BPRHS participants used NSAIDs, we did not find that the use of these medications was associated with cognitive function. Instead, we found a modest reduction in tumor necrosis factor-alpha (TNF-α) among those who took NSAIDs.

To our knowledge perceived stress and cognition were not evaluated in the matrix of systemic inflammation and NSAID use in an understudied adult population with high prevalence of cardiometabolic disease. This work suggests that psychological stress and systemic inflammation may be modifiable risk factors of cognitive decline, and that managing stress and reducing systemic inflammation may be an important factor in maintaining cognitive function, which may help guide future public health interventions.