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   News & Perspective Multispecialty   
   Medscape Medical News > Psychiatry   
   Anxiety Tied to Dementia   
   Nancy A. Melville   
   July 27, 2016   
       
   Anxiety may be associated with an increased risk for cognitive decline and   
   dementia, with the strongest associations in older patients, a new   
   meta-analysis focusing on community populations shows.   
      
      
   "Irrespective of the association is causal or not, it is important for the   
   clinician to be aware of anxiety as a possible predictor for dementia,   
   especially when the anxiety emerges at late life," the investigators, with   
   first author Bernice Gulpers,    
   Department of Psychiatry and Psychology, the School for Mental Health and   
   Neuroscience, Maastricht University Medical Center, and Alzheimer Center   
   Limburg, the Netherlands, write.   
      
   Mild cognitive impairment (MCI) is a known risk factor for dementia, and   
   although depression and anxiety have been shown to be the most common   
   psychiatric disorders that copresent with MCI, most research has focused on   
   depression, the authors note.   
      
   To better understand the role of anxiety, the researchers conducted a   
   literature search of longitudinal studies published through January 2015 that   
   focused on anxiety as a possible risk factor for cognitive decline.   
      
   The findings were published online July 4 in the American Journal of Geriatric   
   Psychiatry.   
      
   Among 20 studies that met inclusion criteria, anxiety was found to predict   
   incident cognitive impairment in the community in four studies, which included   
   4155 patients (risk ratio [RR], 1.77; P < .001). Incident dementia was found   
   to predict cognitive    
   impairment in six studies, which included 6004 patients (RR = 1.57; P = .04).   
      
   The association between anxiety and dementia was stronger among individuals   
   aged 80 years and older (RR, 2.51; P < .01) in comparison with people younger   
   than 80 years (RR, 1.23; P < .33).   
      
   Among cases of clinical MCI in patients recruited at memory clinics, the link   
   between anxiety and the conversion to dementia was not statistically   
   significant (RR = 1.21; P = .20), which may the result of referral bias, the   
   authors note.   
      
   "This finding highlights that people should be cautious with interpreting   
   results from clinical samples, as they often cannot be generalized to the   
   general population," the researchers note.   
      
   In terms of a relationship between anxiety and a decline in individual   
   cognitive domains, studies were too heterogeneous to be pooled. No association   
   was seen in domains of speed of information processing, attention, language,   
   verbal fluency, and    
   visuospatial functioning.   
      
   "We only found some suggestions that anxiety predicts rate of decline on   
   executive functioning, but this is inconclusive," the investigators write.   
      
   Hypotheses regarding mechanisms behind anxiety as a possible causative factor   
   influencing cognitive decline and dementia include hypercortisolism,   
   cardiovascular disease, low-grade inflammation, brain-derived neurotrophic   
   factor suppression, and the    
   cognitive reserves.   
      
   "There are studies which found evidence for all these different hypotheses,"   
   Gulpers told Medscape Medical News.   
      
   For example, it has been suggested that cortisol-induced overstimulation of   
   glucocorticoid receptors in the medial temporal lobe may lead to hippocampus   
   atrophy and that the physiologic reactions to anxiety, including increased   
   heart rate and blood    
   pressure, which are associated with cardiovascular disease, could lead to   
   subsequent vascular dementia.   
      
   "Dementia, however, is a broad diagnosis which involves different etiologies   
   ― for example, Alzheimer's disease and vascular dementia," Gulpers said. "I   
   personally do not think that only one hypothesis is going to fully explain the   
   association between    
   anxiety and the dementia syndrome, if it even is causally related."   
      
   A better understanding of the role of anxiety, however, could have important   
   clinical implications, she added.   
      
   "Treatment of anxiety complaints is very important, independent of whether it   
   is causally related or not," Gulpers said.   
      
   "[If] anxiety is a causal factor leading to cognitive decline and dementia,   
   the regular treatment of cognitive-behavioral therapy could potentially slow   
   the progression. But when anxiety is a prodromal symptom of dementia, a better   
   approach would be the    
   structuring of daily life," she added.   
      
   Am J Geriatr Psychiatry. Published online July 4, 2016. Abstract   
      
       
      
      
   http://www.medscape.com/viewarticle/866696   
      
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