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Alzheimer's, Dementia & Mental Health

Anxiety Hastens Alzheimer's for Seniors with Mild Cognitive Impairment

Late-life depression has been identified as a significant risk marker for Alzheimer's

happy senior with daugher and grandsonNov. 10, 2014 – A new study has identified anxiety as a condition that can hasten the development of Alzheimer’s disease in people with mild cognitive impairment (MCI), who are at risk of slowly developing Alzheimer’s over a few years. Although this study focused on adults over age 54, the news may not be as distressing for senior citizens, who are considerably less likely than younger adults to suffer anxiety disorders.

This study has shown clearly - for the first time, researchers say - that anxiety symptoms in older individuals diagnosed with MCI increase the risk of a speedier decline in cognitive functions - independent of depression (another risk marker). For MCI patients with mild, moderate or severe anxiety, Alzheimer's risk increased by 33%, 78% and 135% respectively.

The research team, led by researchers at Baycrest Health Sciences' Rotman Research Institute, Toronto, Canada, also found that MCI patients who had reported anxiety symptoms at any time over the follow-up period had greater rates of atrophy in the medial temporal lobe regions of the brain, which are essential for creating memories and which are implicated in Alzheimer's.

 

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People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety. (See more about anxiety below news story.)

Until now, anxiety as a potentially significant risk marker for Alzheimer's in people diagnosed with MCI has never been isolated for a longitudinal study to gain a clearer picture of just how damaging anxiety symptoms can be on cognition and brain structure over a period of time.

There is a growing body of literature that has identified late-life depression as a significant risk marker for Alzheimer's. Anxiety has historically tended to be subsumed under the rubric of depression in psychiatry. Depression is routinely screened for in assessment and follow-up of memory clinic patients; anxiety is not routinely assessed.

"Our findings suggest that clinicians should routinely screen for anxiety in people who have memory problems because anxiety signals that these people are at greater risk for developing Alzheimer's," said Dr. Linda Mah, principal investigator on the study, clinician-scientist with Baycrest's Rotman Research Institute, and assistant professor in the Department of Psychiatry at the University of Toronto.

Dr. Mah is also a co-investigator in a multi-site study lead by the Centre for Addiction and Mental Health, and partially funded by federal dollars (Brain Canada), to prevent Alzheimer's in people with late-life depression or MCI who are at high risk for developing the progressive brain disease.

"While there is no published evidence to demonstrate whether drug treatments used in psychiatry for treating anxiety would be helpful in managing anxiety symptoms in people with mild cognitive impairment or in reducing their risk of conversion to Alzheimer's, we think that at the very least behavioral stress management programs could be recommended. In particular, there has been research on the use of mindfulness-based stress reduction in treating anxiety and other psychiatric symptoms in Alzheimer's --and this is showing promise," said Dr. Mah.

The findings were reported on Oct. 29 online by The American Journal of Geriatric Psychiatry, ahead of print publication, scheduled for May 2015.

The Baycrest study accessed data from the large population-based Alzheimer's Disease Neuroimaging Initiative to analyze anxiety, depression, cognitive and brain structural changes in 376 adults, aged 55 - 91, over a three-year period. Those changes were monitored every six months. All of the adults had a clinical diagnosis of amnestic MCI and a low score on the depression rating scale, indicating that anxiety symptoms were not part of clinical depression.

MCI is considered a risk marker for converting to Alzheimer's disease within a few years. It is estimated that half-a-million Canadians aged 65-and-older have MCI, although many go undiagnosed. Not all MCI sufferers will convert to Alzheimer's - some will stabilize and others may even improve in their cognitive powers.

The Baycrest study has yielded important evidence that anxiety is a "predictive factor" of whether an individual with MCI will convert to Alzheimer's or not, said Dr. Mah. Studies have shown that anxiety in MCI is associated with abnormal concentrations of plasma amyloid protein levels and T-tau proteins in cerebrospinal fluid, which are biomarkers of Alzheimer's. Depression and chronic stress have also been linked to smaller hippocampal volume and increased risk of dementia.

In addition to Dr. Mah, the research team included Dr. Malcolm Binns (statistician scientist at Baycrest's Rotman Research Institute, and assistant professor of the Dalla Lana School of Public Health at the University of Toronto), and Dr. David Steffens (Department of Psychiatry, University of Connecticut Health Center).

The study was supported by the National Institutes of Health, and the Geoffrey H. Wood Foundation.


About Anxiety (MedlinePlus)

Fear and anxiety are part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful - it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it.

But for millions of people in the United States, the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders.

Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year, causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder. Types include

>> Panic disorder

>> Obsessive-compulsive disorder

>> Post-traumatic stress disorder

>> Phobias

>> Generalized anxiety disorder

Treatment can involve medicines, therapy or both.

More at NIH: National Institute of Mental Health

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