Background
Because anxiety is postulated as a risk factor for dementia, we performed a systematic
review and meta-analysis to investigate whether anxiety predicts cognitive decline
and/or dementia, taking the stage of cognitive decline as well as setting into account.
Methods
A systematic literature search up to January 2015 was performed to identify all longitudinal
studies on the association between anxiety and cognition. Data extraction and methodological
quality assessment were conducted independently by two authors. Where possible, pooled
relative risks were calculated to examine anxiety as a possible risk factor for cognitive
decline cognitive impairment and dementia in community studies (objective 1), as well
as for conversion to dementia patients referred to memory clinics (objective 2).
Results
Twenty studies met inclusion criteria. Data on cognitive decline were too heterogeneous
for meta-analysis. Anxiety predicted incident cognitive impairment (4 studies, relative
risk [RR]: 1.77, 95% confidence interval [CI]: 1.38–2.26, z = 4.50, p < 0.001) and
dementia (6 studies, RR: 1.57, 95% CI: 1.02–2.42, z = 2.05, p = 0.040) in the community,
the latter driven by studies with a mean age of 80 years or above. Among clinical
mild cognitive impairment samples, anxiety did not predict conversion to dementia
(RR: 1.21, 95% CI: 0.90–1.63, z = 1.28, p = 0.200).
Conclusions
Anxiety is associated with an increased risk for cognitive impairment and dementia
in the community. Stronger associations were driven by higher age, suggesting that
it is a prodromal symptom. Causal biological pathways have also been described, which
could explain the risk for incident cognitive impairment in the community. Future
studies should include mediating mechanism when studying anxiety as a predictor for
cognitive decline and/or dementia.
Key Words
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Article info
Publication history
Published online: July 04, 2016
Accepted:
May 19,
2016
Received in revised form:
May 16,
2016
Received:
February 28,
2016
Identification
Copyright
© 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
