May 03, 2018
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Midlife anxiety may increase later dementia risk

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Results from a systematic review showed clinically significant midlife anxiety was associated with an increased risk for dementia over a period of at least 10 years.

“To date, there has been no systematic review to investigate the association between clinically significant anxiety and dementia,” Amy Gimson, MBBS, from the faculty of medicine, University of Southampton, England, and colleagues wrote in BMJ Open. “It is possible that anxiety symptoms meeting diagnostic threshold will have a stronger association with dementia than general symptoms because this has been shown with depression.”

The investigators performed a systematic review of the literature examining the link between clinically significant levels of anxiety and dementia risk over a longer time scale of 10 or more years using clinical databases. They included population-based articles that measured clinically significant anxiety in isolation or after controlling for symptoms of depression and discussed the link between anxiety assessment and dementia diagnosis of at least 10 years. They also conducted methodological quality assessments and measured outcome data for all-cause dementia.

Of four eligible high-quality studies of 29,819 participants included in the analysis, all showed a positive association between clinically significant anxiety and dementia. Specifically, all studies found a significant increase in the number of dementia diagnoses in patients who experienced clinical anxiety diagnosis or clinically significant anxiety symptoms at least 10 years, on average, before dementia diagnosis.

Furthermore, the studies that examined lifelong diagnoses of anxiety found a stronger relationship between midlife anxiety and later dementia diagnosis compared with prospective studies that examined the relationship over the short-term. One study showed the link between high anxiety and dementia diagnosis remained even when participants who developed dementia within 5 years of baseline assessment were excluded, according to the authors. They did not conduct a meta-analysis because of the heterogeneity between studies.

“This review expands our understanding of anxiety as a potentially modifiable risk for dementia,” Gimson and colleagues wrote. “To improve the rate of earlier diagnosis of dementia, close monitoring of subtle cognitive decline in older adults with a history of anxiety, depression and cerebrovascular disease would be encouraged. Given the limited number of studies investigating the anxiety–dementia relationship, further research is required to assess underlying mechanisms that link these disorders and to disambiguate anxiety’s potential role as a risk factor as separate from a prodromal symptom of dementia.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.