Late-Life Anxiety Linked to Cognitive Decline

Symptoms of anxiety in women over 50 appear to be associated with a decline over time in executive function—the ability to plan ahead and organize one’s thoughts, according to a report published September 14 in the American Journal of Geriatric Psychiatry.

Among both men and women 65 years and older, anxiety appears to predict a decline in verbal memory, which refers to the ability to remember words.

Lead author Sebastian Köhler, Ph.D., an associate professor of neuroepidemiology at Maastricht University, told Psychiatric News that the findings support some research suggesting that anxiety in older adults could be a sign of dementia yet to come.

“Anxiety symptoms in older adults are associated with a faster memory decline, and among women anxiety is also associated with decline in non-memory functions,” Köhler said. “High late-life anxiety symptoms might be an at-risk state for dementia. If causal, adequate treatment of anxiety symptoms might lower the risk for further cognitive deterioration.”

Köhler and colleagues analyzed data on 918 participants who were 50 years of age or older in the Maastricht Aging Study, a longitudinal population-based study of factors associated with cognitive aging in the Netherlands.

They measured anxiety at baseline using the anxiety subscale of the Symptom Check List-90 (SCL-90). The participants were asked to answer 10 questions, rating the degree of a specific anxiety symptom on a five-point scale.

The total score was calculated by adding up the individual scores per question. For the purposes of the analysis, Köhler and colleagues tallied the results in two ways: as a continuous score of severity and as a dichotomous score (high anxiety/no high anxiety), with high anxiety defined as being the highest quartile on the severity scale.

The participants also underwent neuropsychological testing, which measured executive function, memory, speed of information processing, and verbal fluency. The neuropsychological tests were repeated every three years during a 12-year follow-up. (Köhler said anxiety symptoms were also measured throughout the 12-year follow-up, but for the purposes of this analysis, the researchers looked only at the relationship of baseline anxiety to cognitive decline.)

Overall, being in the highest quartile of anxiety symptoms (“high anxiety”) did not predict a faster decline in executive functioning over time in men and women. However, among women, higher anxiety on the continuous measure of severity was associated with a worse cognitive trajectory. A similar sex-specific effect was found for processing speed and verbal fluency.

In contrast, faster decline in verbal memory was associated with “high anxiety” irrespective of sex but was more pronounced in those 65 years and older.

Köhler and colleagues speculate that the stronger association of anxiety with cognitive decline in women may indicate that women experience a more severe form of anxiety. That theory is borne out by the fact that women in the Maastricht Aging Study have a higher prevalence and higher severity of symptoms than men. “Previous research has also shown an increased risk for coronary heart disease in women with anxiety symptoms,” Köhler and colleagues wrote. “Since the vascular disease burden could potentially mediate the association between anxiety and deterioration of executive function, this may explain these sex-specific findings as well.”

Köhler and colleagues noted that it is unclear whether late-life anxiety might be a prodromal form of dementia or causally related to neurodegeneration. “A recent meta-analysis found suggestions for anxiety as a prodromal symptom of neurodegenerative diseases,” they wrote. “Anxiety could then be a consequence of diminished cognitive capacities which are only experienced on a subjective level. Further longitudinal research is needed to fully understand the relationship between anxiety and cognition including potentially mediating mechanisms.”  ■