Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review

Abstract

ObjectivesAnxiety is an increasingly recognised predictor of cognitive deterioration in older adults and in those with mild cognitive impairment. Often believed to be a prodromal feature of neurodegenerative disease, anxiety may also be an independent risk factor for dementia, operationally defined here as preceding dementia diagnosis by ≥10 years.DesignA systematic review of the literature on anxiety diagnosis and long-term risk for dementia was performed following published guidelines.Setting and participantsMedline, PsycINFO and Embase were searched for peer-reviewed journals until 8 March 2017. Publications reporting HR/OR for all-cause dementia based on clinical criteria from prospective cohort or case–control studies were selected. Included studies measured clinically significant anxiety in isolation or after controlling for symptoms of depression, and reported a mean interval between anxiety assessment and dementia diagnosis of at least 10 years. Methodological quality assessments were performed using the Newcastle-Ottawa Scale.Outcome measureHR/OR for all-cause dementia.ResultsSearches yielded 3510 articles, of which 4 (0.02%) were eligible. The studies had a combined sample size of 29 819, and all studies found a positive association between clinically significant anxiety and future dementia. Due to the heterogeneity between studies, a meta-analysis was not conducted.ConclusionsClinically significant anxiety in midlife was associated with an increased risk of dementia over an interval of at least 10 years. These findings indicate that anxiety may be a risk factor for late-life dementia, excluding anxiety that is related to prodromal cognitive decline. With increasing focus on identifying modifiable risk factors for dementia, more high-quality prospective studies are required to clarify whether clinical anxiety is a risk factor for dementia, separate from a prodromal symptom.

Repetitive Negative Thinking is associated with Subjective Cognitive Decline in older adults: a cross-sectional study

“…This shift in research orientation has led to a growing interest in (i) refining risk factor profiles for dementia and early presentations of potential dementia (e.g., SCD, mild cognitive impairment) (1, 7), and (ii) developing preventative intervention approaches (8)(9)(10)(11). Alongside well-established cardiovascular risk factors such as hypertension, obesity, physical inactivity, and smoking (7,13), psychological risk factors, such as depression and anxiety, are emerging as promising intervention targets (14)(15)(16). An aspect frequently found in psychological risk factors associated with dementia risk is repetitive negative thinking (RNT).…”

“…Increasing evidence supports RNT as a style of thinking that operates across different mental health disorders (i.e., a transdiagnostic process) (18) that have been associated with an increased vulnerability to dementia and cognitive decline (19). For instance, RNT contributes to the development and maintenance of depression, anxiety, and post-traumatic stress disorder (20)(21)(22), all of which have been associated with cognitive decline and increased vulnerability to dementia (e.g., 16,23,24). It is possible that the increased risk of dementia conferred by these mental health disorders may be driven by RNT.…”

The Impact of the Virtual Cognitive Health Program on the Cognition and Mental Health of Older Adults: Pre-Post 12-Month Pilot Study (Preprint)

“…[30][31][32] Secondary outcomes included change in PHQ-9 depression severity scores and change in GAD-7 anxiety severity scores from baseline to week 24 and week 52, as both depression and anxiety are risk factors for AD. 33,34 RBANS, PHQ-9 and GAD-7 data were also collected at week 12 to allow for interim non-primary analysis. Exploratory analyses assessed the association between various engagement measures with the VC Health Program and change in RBANS, PHQ-9, and GAD-7 scores.…”

Should benzodiazepines be avoided?

“…Furthermore, the authors adjust for socioeconomic position, several comorbidities, and other medication. However, to limit residual confounding, it is important that covariates are included with sufficient detail and it is puzzling why the authors lump all psychiatric diagnosis in one category instead of a more detailed adjustment for diseases strongly associated with BZD and dementia such as depression and anxiety . The lack of dose–response relation is also surprising given the large range of exposure from those who once purchased BZD to heavy long‐term users.…”