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Anxiety as a Risk Factor for Cognitive Decline: A 12-Year Follow-Up Cohort Study

  • Bernice J.A. Gulpers
    Affiliations
    MET GGZ Maastricht (BG), Regional Institute for Mental Health Care in Outpatients, Maastricht, Netherlands

    Department of Psychiatry and Neuropsychology (BG, MPJvB, FRJV, SK), School for Mental Health and Neuroscience and Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, Netherlands
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  • Richard C. Oude Voshaar
    Affiliations
    Center for Psychiatry & Interdisciplinary Center of Psychopathology of Emotion Regulation (RCOV), University Medical Center Groningen, Groningen, Netherlands
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  • Martin P.J. van Boxtel
    Affiliations
    Department of Psychiatry and Neuropsychology (BG, MPJvB, FRJV, SK), School for Mental Health and Neuroscience and Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, Netherlands
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  • Frans R.J. Verhey
    Affiliations
    Department of Psychiatry and Neuropsychology (BG, MPJvB, FRJV, SK), School for Mental Health and Neuroscience and Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, Netherlands
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  • Sebastian Köhler
    Correspondence
    Send correspondence and reprint requests to Sebastian Köhler, Ph.D., PO Box 616 (DRT12), Maastricht, Netherlands 6200 MD.
    Affiliations
    Department of Psychiatry and Neuropsychology (BG, MPJvB, FRJV, SK), School for Mental Health and Neuroscience and Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, Netherlands
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Published:September 14, 2018DOI:https://doi.org/10.1016/j.jagp.2018.09.006

      HIGHLIGHTS

      • We investigated which cognitive domains are affected by anxiety in a twelve year follow-up cohort study.
      • Anxiety symptoms were associated with a decline of verbal memory in older adults and with poorer performance in non-amnestic domains in women.
      • Adequate treatment of anxiety symptoms could potentially beneficially influence the risk for developing neurodegenerative disease.

      Objective

      Anxiety might be a risk factor for cognitive decline, but previous studies had short follow-up or small sample sizes or studied general or single cognitive domain functioning.

      Methods

      Anxiety symptoms were assessed with the Symptom Checklist-90 in 918 participants of the Maastricht Aging Study aged 50 years or older. Anxiety was analyzed both dichotomously (highest versus lower quartiles as a group) and continuously. Neuropsychological tests measured executive function, memory, speed of information processing, and verbal fluency. Linear mixed models were conducted with anxiety symptoms as predictor and change in cognitive scores as outcome. Differences of associations by age and gender were studied with three-way interactions.

      Results

      Higher anxiety symptoms were significantly associated with more decline in verbal memory in those aged 65 years and older (delayed recall: χ2 = 9.30, df = 2, p = 0.01; immediate recall: χ2 = 11.81, df = 2, p = 0.003). There were sex differences in executive function (χ2 = 6.63, df = 2, p = 0.036), fluency (χ2 = 6.89, df = 2, p = 0.032), and processing speed (χ2 = 8.83, df = 2, p = 0.012), with lower performance in women over time.

      Conclusion

      In participants without cognitive impairments at baseline, anxiety symptoms were associated with a decline in verbal memory in older adults and with poorer performance in nonamnestic domains in women. Adequate treatment of anxiety symptoms could have a beneficial influence on the risk of developing neurodegenerative diseases. Further research is needed to elucidate whether this association is causal.

      Key Words

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