The latest from Cogstate, leaders in optimizing the measurement of cognition

Connection Found Between Anxiety, Amyloid and Cognitive Change

February 2, 2015

aiblAs we grow older, most of us have plenty on our minds that can cause some level of anxiety at times.  Worries about our family and career are part of a normal life.  However, when those feelings reach a certain level, they may combine with other changes in the brain to accelerate cognitive disorders such as dementia and Alzheimer’s disease.  In a new study, appearing online first in JAMA Psychiatry, researchers have found a link between higher anxiety symptoms and cognitive decline in adults who also have elevated levels of amyloid-β (Aβ).

Numerous previous studies have shown that the accumulation of clumps of amyloid plaque in the brain will eventually lead to cognitive decline in memory and often a diagnosis of mild cognitive impairment or dementia.  This unfortunate path varies from person to person leading researchers to look for other mitigating factors, such as genetics or psychological health.

Specifically, understanding the effect of anxiety or depression symptoms on cognitive decline may help physicians to prescribe treatment programs that could slow the inevitable deterioration from high levels of Aβ.

As part of the Australian Imaging, Biomarkers and Lifestyle (AIBL) Research Group, Robert H. Pietrzak, PhD, MPH of Yale University, studied the data from 333 healthy, older adults at hospital-based research clinics to determine the interplay between Aβ, anxiety and cognitive decline.  The test group underwent several tests, including an imaging scan to identify amyloid plaques, the Hospital Anxiety and Depression Scale (HADS), the Memory Complaint Questionnaire and a full neuropsychological assessment that included the Cogstate Brief Battery.

Of the full group, 84 adults were found to have elevated levels of Aβ. As confirmed in other studies, this group was already at a disadvantage in terms of cognitive performance.  Next, the HADS results divided the group again into a high versus low anxiety.  Since the AIBL population had already been screened for serious mental health issues, a score of 8 out of the 21 point scale was used to determine the dividing line. Of the high Aβ group, 36 adults were found to have a high level of anxiety.

Questions on the HADS related to anxiety include:

  • I feel tense or wound up
  • I get a sort of frightened feeling as if something bad is about to happen
  • Worrying thoughts go through my mind
  • I can sit at ease and feel relaxed
  • I get a sort of frightened feeling like butterflies in the stomach
  • I feel restless and have to be on the move
  • I get sudden feelings of panic

The cognitive health of the entire test population was measured at baseline, 18, 36 and 54 month intervals, providing a meaningful, longitudinal record of results.  As expected, the presence of high amyloid plaques at baseline already had a negative impact on performance across the board in memory, attention, language, executive function and visuospatial ability.

However, within the high amyloid group, those with high anxiety symptoms showed a significantly greater rate of decline over time in global cognition, verbal memory, language and executive function than the low anxiety group.

“The results of our study suggest that among older adults with a positive beta-amyloid scan, those with elevated anxiety symptoms show a more rapid decline in global cognition, verbal memory, language, and executive function over a 54-month period,” said Dr. Pietrzak. “This suggests that increased levels of anxiety increase the development of the symptoms of Alzheimer’s disease.  Thus, assessment, monitoring, and treatment of such symptoms, even subclinical levels, may help inform risk stratification and management of preclinical and prodromal phases of Alzheimer’s disease”.

Questions or comments? Please contact Dan Peterson