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 adults with poorer cognitive functioning tend to display 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 Journal of Affective Disorders.

An anxiety disorder is a type of mental health condition where a person tends to respond to certain things with fear and dread in a way that is an obvious overreaction. Things that would not provoke such an intensive emotional reaction or would not provoke an emotional reaction at all in persons without this disorder can cause intensive fear responses in individuals suffering from an anxiety disorder.

While it is normal to have some anxiety, particularly when facing an important problem, decision or when in objective danger, an anxiety disorder goes far beyond this. It seriously impairs one’s ability to function and prevents a person from controlling his/her reactions in situations causing anxiety.

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

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

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

Study author Bernice J. A. Gulpers and her colleagues wanted to study the details of the association between poor cognitive functioning and anxiety disorders in a population of older adults. They analyzed data from the Maastricht Study, a large observational study of adults between 40 and 75 years of age, 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 were analyzed.

Participants completed assessments of generalized anxiety symptoms, and anxiety disorders including the 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 for assessing cognitive functioning, and assessments of executive functioning.

Results showed that participants with a diagnosis of panic disorder or agoraphobia tended to be younger, with lower education, more often women. They more often suffered from type 2 diabetes and depression. Such participants tended to have poorer executive functioning and memory along with lower cognitive processing speed and cognitive impairments.

The diagnosis of agoraphobia was associated with worse cognitive functions (in all domains) and higher likelihood of cognitive impairment. Younger participants with agoraphobia were more likely to be cognitively impaired than older participant with this diagnosis. The same was the case with memory. Adults with agoraphobia and type 2 diabetes had lower average cognitive processing speed and were more likely to be cognitively impaired that those with agoraphobia, but without type 2 diabetes.

Participants with more pronounced symptoms of generalized anxiety were more likely to be cognitively impaired, had, on average, lower cognitive processing speed. More pronounced symptoms of generalized anxiety were associated with executive functioning in younger, 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 without it.

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

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

“Panic disorder was not associated with executive function but with memory. There were no significant associations for lifetime panic disorder and the cognitive domains or odds of cognitive impairment. Associations were stronger in the younger participants, and for agoraphobia and GAD-7 [general anxiety] scores also in those 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 cause-and-effect conclusions. Additionally, some aspects of cognitive functioning, such as visual memory or language were not examined.

The study, “Anxiety and cognitive functioning in the Maastricht study: A cross-sectional population study”, was authored by Bernice J.A. Gulpers, Frans R.J. Verhey, Simone J.P.M. Eussen, Miranda T. Schram, Bastiaan E. de Galan, Martin P.J. van Boxtel, Coen D.A. Stehouwer, and S. Kohler.