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

2020

Psychol. Med.

Background Affective neuroscience and scar theories propose that increased excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts future declines in executive functioning (EF). However, the preponderance of cross-sectional designs used to examine between-person chronic worry–EF relationships has blocked progress on understanding their potentially causal within-person associations. Accordingly, this study used bivariate dual latent change score (LCS) models to test whether within-person increased GAD severity might relate to future reduced EF. Methods Community-dwelling adults (N = 2581, 46 years on average, s.d. = 11.40, 54.71% female) were assessed for GAD symptom severity (Composite International Diagnostic Interview-Short Form) across three waves, spaced about 9 years apart. Three aspects of EF [inhibition, set-shifting, and mixing costs (MCs; a measure related to common EF)], were assessed with stop-and-go switch tasks. Participants responded to 20 normal and 20 reverse single-task block trials and 32 mixed-task switch block trials. EF tests were administered at time 2 (T2) and time 3 (T3), but not at time 1 (T1). Results After controlling for T1 depression, LCS models revealed that within-person increased T1 − T2 GAD severity substantially predicted future reduced T2 − T3 inhibition and set-shifting (both indexed by accuracy and latency), and MC (indexed by latency) with moderate-to-large effect sizes (|d| = 0.51–0.96). Conclusions Results largely support scar theories by offering preliminary within-person, naturalistic evidence that heightened excessive worry can negatively predict future distinct aspects of cognitive flexibility. Effectively targeting pathological worry might prevent difficulties arising from executive dysfunction.

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confidence: 89%

Within-person increase in pathological worry predicts future depletion of unique executive functioning domains

2020

Psychol. Med.

“…Another study found that in older adults heightened anxiety symptoms correlated with decline in verbal memory over 12 years (Gulpers, Oude Voshaar, van Boxtel, Verhey, & Köhler, 2019).…”

Section: Introductionmentioning

confidence: 97%

“…First, initial levels of higher neuroticism were connected with initial levels of poorer processing speed, visuospatial WM, and recognition memory in Swedish adult twins (Wetherell, Reynolds, Gatz, & Pedersen, 2002); however, in this study, neuroticism was not associated with 9‐year cognitive decline. Another study found that in older adults heightened anxiety symptoms correlated with decline in verbal memory over 12 years (Gulpers, Oude Voshaar, van Boxtel, Verhey, & Köhler, 2019). Relatedly, higher self‐reported depression symptom severity was associated with dementia after 9 years (Köhler, van Boxtel, Jolles, & Verhey, 2011).…”

Section: Introductionmentioning

confidence: 99%

Larger increase in trait negative affect is associated with greater future cognitive decline and vice versa across 23 years

2020

Depression and Anxiety

Background Trait negative affect (NA) is a central feature of anxiety and depression disorders. Neurocognitive and scar models propose that within‐person increase in NA across one period of time relates to a decline in cognitive functioning at a future period of time and vice versa. Yet, there has been little research on whether a within‐person change in trait NA across one time‐lag precedes and is associated with a change in cognition across a future time lag and vice versa. Due to a growing aging population, such knowledge can inform evidence‐based prevention. Methods Participants were 520 dementia‐free community‐dwelling adults (mean age = 59.76 years [standard deviation = 8.96], 58.08% females). Trait‐level NA (negative emotionality scale), spatial cognition (block design and card rotations), verbal working memory (WM; digit span backward), and processing speed (symbol digit modalities) were assessed at five time points (waves) across 23 years. Bivariate dual latent change score (LCS) approaches were used to adjust for regression to the mean, lagged outcomes, and between‐person variability. Results Unique bivariate LCS models showed that within‐person increase in trait NA across two sequential waves was related to declines in spatial cognition, verbal WM, and processing speed across the subsequent two waves. Moreover, within‐person reductions in spatial cognition, verbal WM, and processing speed across two sequential waves were associated with future increases in trait NA across the subsequent two waves. Conclusions Findings concur with neurobiological and scar theories of psychopathology. Furthermore, results support process‐based emotion regulation models that highlight the importance of verbal WM, spatial cognition, and processing speed capacities for downregulating NA.

“…. Likewise, among mid-life and older community adults, increased anxiety was related to reduced immediate and delayed auditory memory abilities following 12 years [26]. Similarly, 2 metaanalyses of 43 studies showed that heightened anxiety and depression dovetailed with larger EF decline and incidence of major neurocognitive disorders in diverse community and clinical samples across 1-17 years [27,28].…”

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confidence: 92%

Depression and executive functioning bidirectionally impair one another across 9 years: Evidence from within-person latent change and cross-lagged models

2021

Eur. Psychiatr.

Background: Scar and vulnerability models assert that increased psychopathology may predict subsequent executive functioning deficits (and vice versa) over protracted timescales, yet most prior work on this topic has been cross-sectional. Thus, we tested the within-and betweenperson relations between EF, depression and anxiety. Method: Older adult participants (n = 856) were assessed across 4 waves, approximately 2 years apart. Performance-based EF and caregiver-rated symptom measures were administered. Bivariate latent change score and random-intercept cross-lagged panel models were conducted. Results: Within persons, RI-CLPMs revealed that prior greater depression forecasted lower subsequent EF, and vice versa (d = -0.292 vs. -0.292). BCS models showed that within-person rise in depression predicted EF decreases, and vice versa (d = -0.245 vs. -0.245). No within-person, cross-lagged, EF-anxiety Accepted manuscript: Authors' Copy MENTAL HEALTH AND EXECUTIVE FUNCTIONING 2 relations emerged. Further, significant negative between-person EF-symptom relations were observed (d = -0.264--0.395). Discussion: Prospective, within-person findings offer some evidence for developmental scar and vulnerability models.