A growing body of research reveals that the prevalence of late-life anxiety
coexisting with cognitive impairment is more common than may have been
suspected. And it appears that a symbiotic relationship exists between the
These are the conclusions drawn by Stanford University School of Medicine
researchers Sherry Beaudreau, Ph.D., and Ruth O'Hara, Ph.D., from their
literature review on the subject. Their study was published in the October
American Journal of Geriatric Psychiatry.
"We conducted an extensive literature search using PubMed, and [we]
also included relevant articles that were listed in the references of the
articles we found," Beaudreau, the study's lead author, told
Psychiatric News. "Preliminary evidence suggests that the
impact of both [late-age anxiety and cognitive impairment] is greater than for
either one alone. However, much work needs to be done in this area."
Beaudreau is a clinical assistant professor with the Department of
Psychiatry and Behavioral Sciences at Stanford University School of Medicine.
O'Hara is an associate professor in the same department. Both are affiliated
with the Veterans Affairs Palo Alto Health Care System.
The two mined the research for evidence that might show whether there is a
higher prevalence of anxiety in cognitively impaired individuals in their
later years, whether there is a causal relationship between heightened levels
of anxiety in this population and poorer cognitive functioning, and whether
such anxiety can predict future cognitive decline in this age group.
These are important questions, they said, because if there is a
cause-and-effect relationship between the two conditions it may likely explain
the "poorer treatment prognosis for both." They said that this, in
turn, could be the basis for calling for more targeted research to better
understand the preclinical development of dementia and for determining the
best ways to treat late-life anxiety.
"A significant clinical concern is which problem to treat first when
both anxiety and cognitive impairment are present," Beaudreau and O'Hara
wrote. "Augmenting or combining standard treatments [pharmacology for
cognitive problems and psychotherapy for anxiety] is an important venue for
researchers and clinicians to consider."
The literature makes clear that "anxiety disorders are the most
common late-life psychiatric diagnoses, with an estimated lifetime prevalence
of 15.3 percent in older adults, surpassing population estimates for mood
disorders and severe cognitive impairment," the researchers found. So
although late-life depression, especially related to loss, is an important
issue and has been researched more, "the reciprocal relationship between
late-life anxiety and cognition merits attention," which is why they
embarked on this study.
Because generalized anxiety disorder (GAD) is the primary type of anxiety
discussed in the literature, GAD became the exclusive focus of the review. It
has a lifetime prevalence of 10.2 percent in older individuals, according to a
longitudinal study in the Netherlands of 3,056 adults aged 55 to 85 reported
in 1998 by Aartjan Beekman, M.D., Ph.D., and colleagues in the
International Journal of Geriatric Psychiatry. Symptoms include an
overly excessive apprehension of or preoccupation over the daily events and
activities of life.
As many as 30 percent of adults experience mild cognitive impairment, the
authors determined via their literature review.
Overall, the research reviewed by Beaudreau and O'Hara, while not
conclusive, revealed more than a casual relationship between GAD and mild
"Although the influence of GAD or worry symptoms on cognitive
functioning is not well delineated in the literature, there is some evidence
for reduced cognitive performance, in particular reduced episodic memory and
executive function in young and middle-aged adults with anxiety
disorder," they noted.
Some speculate that structural changes in the brain may be implicated in
late-life anxiety and cognitive changes. "One of the few such studies...
implicates functional impairments in the dorsolateral region of the prefrontal
cortex, an area strongly influencing diverse cognitive processes, particularly
executive functions," reported Sanjay Mathew, M.D., and colleagues in an
imaging study reported in the June 2004 American Journal of
Meanwhile, a number of cross-sectional studies have found that older adults
who exhibited cognitive deficits had more symptoms of anxiety than did control
subjects and that there was a relationship between poorer cognitive
functioning in older adults and heightened anxiety. Chief among these studies
are "Prevalence of Neuropsychiatry Symptoms in Dementia and Mild
Cognitive Impairment," by Constantine Lyketsos, M.D., and colleauges in
the September 2002 JAMA, and "De Nova Genesis of
Neuropsychiatric Symptoms in Mild Cognitive Impairment" by Yonas Geda,
M.D., and colleagues reported in the April 2004 International
Beaudreau and O'Hara also identified a few longitudinal studies that
determined that the level of an elderly individual's anxiety could be "a
predictor of future cognitive decline." Chief among these was one by
Gary Sinoff and Perla Werner in the September 2003 International Journal
of Geriatric Psychiatry.
The clinically instructive lesson is clear: "treatment focusing on
only one disorder is not likely to be effective," Beekman wrote in a
Journal of Geriatric Psychiatry editorial that critiqued Beaudreau
and O'Hara's review. Then again, "as anxiety is a treatable problem,
this may represent an avenue to prevent or slow down cognitive decline,"
Beekman suggested. He is with the Department of Psychiatry at VU University
Medical Centre and BuitenAmstel Geestgronden Mental Health Institute in
Amsterdam, the Netherlands.
An abstract of "Late-Life Anxiety and Cognitive Impairment: A
Review" is posted at<http://ajgponline.org/cgi/content/abstract/16/10/790>.▪