A large study in the Netherlands found that older adults with poorer cognitive function tend to show symptoms of anxiety and anxiety-related disorders. The association was stronger in relatively younger study participants and those with type 2 diabetes. The study was published in Journal of Mood Disorders.
An anxiety disorder is a type of mental illness in which a person tends to react to certain things with fear and terror in a way that constitutes an apparent overreaction. Things that would not elicit as intense an emotional response, or no emotional response at all, in individuals without the disorder can evoke intense anxiety responses in individuals with an anxiety disorder.
While it’s normal to feel afraid, especially when faced with an important issue, decision, or objective danger, an anxiety disorder goes way beyond that. It seriously impairs functioning and prevents a person from controlling their reactions in situations that cause anxiety.
There are different types of anxiety disorders including generalized anxiety disorder, panic disorder, phobias and separation anxiety. Generalized Anxiety Disorder is a condition in which a person feels a constant sense of overwhelm and over-concern about everyday things. With panic disorder, a person often experiences panic attacks—sudden, intense feelings of anxiety that cause adverse physical symptoms such as racing heart, rapid breathing, sweating and choking, heart attack, or “craziness.”
Phobias are intense fears of certain situations or objects. Often the fear of these objects is disproportionate to the danger posed by such objects and situations. This type of fear can even appear towards completely harmless objects or situations.
Anxiety disorders affect approximately 15% of the population at some point in their lives. Studies have shown that in older adults, higher levels of anxiety are associated with poorer cognitive function. However, it is not entirely clear which aspects of cognitive function are associated with which types of anxiety disorders.
Study author Bernice JA Gulpers and her colleagues set out to explore the details of the association between poor cognitive function and anxiety disorders in a population of older adults. They analyzed data from the Maastricht Study, a large observational study of adults between the ages of 40 and 75 living in the southern part of the Netherlands at the time of the study. The new study analyzed data from 7,689 participants collected between 2010 and 2017.
Participants completed assessments of generalized anxiety symptoms and anxiety disorders, including panic disorder with agoraphobia (fear of open spaces), panic disorder without agoraphobia, and agoraphobia without panic disorder. Participants also completed a concise series of cognitive tests assessing cognitive function and executive function assessments.
Results showed that participants diagnosed with panic disorder or agoraphobia tended to be younger, less educated, and more likely to be women. They were more likely to suffer from type 2 diabetes and depression. Such participants tended to have poorer executive function and memory along with lower cognitive processing speed and cognitive impairment.
A diagnosis of agoraphobia was associated with poorer cognitive functioning (across all domains) and a higher likelihood of cognitive impairment. Younger participants with agoraphobia were more likely to be cognitively impaired than older participants with this diagnosis. It was the same with memory. Adults with agoraphobia and type 2 diabetes had lower average cognitive processing speed and were more likely to be cognitively impaired than those with agoraphobia but without type 2 diabetes.
Participants with more pronounced symptoms of generalized anxiety were more likely to be cognitively impaired and had lower cognitive processing speeds on average. More pronounced symptoms of generalized anxiety were associated with executive functioning in younger but not older participants. Cognitive impairment was more likely in participants with more severe symptoms who also had type 2 diabetes than in participants without type 2 diabetes.
Participants with a panic disorder tended to have poorer memory. Younger participants with a panic disorder were more likely to have cognitive impairment, but this was not the case in older participants.
“We found little support for a specific role for executive dysfunction in anxiety disorders. Agoraphobia was associated with a higher likelihood of cognitive impairment and poorer outcomes in executive functioning, but also in other cognitive domains and of similar magnitude. For high scores on the GAD7 [general anxiety symptoms]the association with executive functioning did not become significant after adjustment for depressive disorders, but remained significant for cognitive impairment,” the researchers concluded.
“Panic disorder was not associated with executive functioning, but with memory. There were no significant associations between lifelong panic disorder and cognitive domains or likelihood of cognitive impairment. Associations were stronger among the younger participants and for agoraphobia and GAD-7 [general anxiety] also scores with people with type 2 diabetes.”
The study sheds light on the connections between anxiety and cognitive functions. However, it should be noted that the study design does not allow for any cause-effect statements. In addition, some aspects of cognitive function, such as visual memory or language, have not been studied.
The study “Anxiety and Cognitive Function in the Maastricht Study: A Cross-Population Study” was authored by Bernice JA Gulpers, Frans RJ Verhey, Simone JPM Eussen, Miranda T Schram, Bastiaan E de Galan, Martin PJ van Boxtel, Coen DA Stehouwer and S. Kohler.