Higher anxiety is associated with worse cognitive functioning and dementia in older adults, study finds

A large-scale study in the Netherlands found that older people with lower cognitive functioning tend to show symptoms of anxiety and anxiety-related disorders. The association was stronger for relatively younger study participants and those with type 2 diabetes. The study was published in the Affective Disorders Diary.

An anxiety disorder is a type of mental health condition where a person tends to react to certain things with fear and dread in a way that is an obvious overreaction. Things that would not cause such an intense emotional response or cause any emotional response in people without this disorder can cause intense fear responses in people with an anxiety disorder.

While it’s normal to have some anxiety, especially when faced with an important issue, decision, or objective danger, an anxiety disorder goes way beyond that. It seriously impairs the ability to function and prevents a person from controlling their reactions in anxiety-provoking situations.

There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, phobias, and separation anxiety. Generalized anxiety disorder is a condition in which a person experiences a constant feeling of being overwhelmed and worrying excessively about everyday things. In panic disorder, a person often experiences panic attacks – sudden, intense feelings of fear that cause unwanted physical symptoms such as a racing heart, rapid breathing, sweating, and a feeling of choking , a heart attack or “going crazy”.

Phobias are intense fears of certain situations or objects. Often the level of fear of these objects is completely disproportionate to the level of danger posed by these objects and situations. This type of fear can be felt even towards completely harmless objects or situations.

Anxiety disorders affect approximately 15% of the population during their lifetime. Studies have shown that, in older adults, higher levels of anxiety are associated with poorer cognitive functioning. However, it is not entirely clear which aspects of cognitive functioning are associated with which types of anxiety disorders.

Study author Bernice JA Gulpers and colleagues set out to investigate the details of the association between poor cognitive functioning and anxiety disorders in an older population. They analyzed data from the Maastricht Study, a large observational study of adults aged 40 to 75, living, at the time of the study, in the southern part of the Netherlands. For the new research, data from 7,689 participants, collected between 2010 and 2017, was analyzed.

Participants completed assessments for symptoms of generalized anxiety and anxiety disorders, including panic disorder with agoraphobia (fear of open spaces), panic disorder without agoraphobia, and agoraphobia without panic disorder. Participants also completed a concise battery of cognitive tests to assess cognitive functioning and assessments of executive functioning.

The results showed that participants diagnosed with panic disorder or agoraphobia tended to be younger, less educated, more often female. They more often suffered from type 2 diabetes and depression. These participants tended to have lower executive functioning and memory, as well as lower cognitive processing speed and cognitive impairment.

The diagnosis of agoraphobia was associated with deterioration in cognitive functions (in all domains) and a higher likelihood of cognitive impairment. Younger participants with agoraphobia were more likely to have cognitive impairment than older participants with this diagnosis. It was the same with memory. Adults with agoraphobia and type 2 diabetes had lower average cognitive processing speed and were more likely to have cognitive impairment than those with agoraphobia but without type 2 diabetes.

Participants with more pronounced symptoms of generalized anxiety were more likely to have cognitive impairment and had, on average, lower cognitive processing speed. More pronounced symptoms of generalized anxiety were associated with executive functioning in younger participants, but not in older participants. Cognitive impairment was more likely in participants with more pronounced symptoms who also had type 2 diabetes than in those who did not.

Participants with panic disorder tended to have poorer memory. Younger participants with panic disorder were more likely to have cognitive impairment, but this was not the case for older participants.

“We found little support for a specific role of executive dysfunction in anxiety disorders. Agoraphobia was associated with higher risks of cognitive impairment and lower scores on executive functioning but also on other cognitive domains, and of a similar magnitude. For high scores on the GAD7 [general anxiety symptoms]the association with executive functioning became non-significant after adjusting for depressive disorder, but remained significant for cognitive impairment,” the researchers concluded.

“Panic disorder was not associated with executive function but with memory. There was no significant association between lifetime panic disorder and cognitive domains or risk of cognitive impairment. Associations were stronger in younger participants, and for agoraphobia and GAD-7 [general anxiety] scores also in people with type 2 diabetes.”

The study sheds light on the links between anxiety and cognitive functioning. However, it should be noted that the study design does not allow for any causal conclusions. Additionally, some aspects of cognitive functioning, such as visual memory or language, were not examined.

[ PubMed ]Bernice JA Gulpers, Frans RJ Verhey, Simone JPM Eussen, Miranda T. Schram, Bastiaan E. de Galan, Martin PJ van Boxtel, Coen, DA and S. Kohler.

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