Skip to main content Accessibility help

Anxiety symptoms and risk of cognitive decline in older community-dwelling men

  • Ahmed M. Kassem (a1), Mary Ganguli (a1) (a2), Kristine Yaffe (a3), Joseph T. Hanlon (a1) (a4), Oscar L. Lopez (a2), John W. Wilson (a5), Jane A. Cauley (a1) and for the Osteoporotic Fractures in Men (MrOS) Study Research Group...



Previous research regarding anxiety as a predictor of future cognitive decline in older adults is limited and inconsistent. We examined the independent relationship between anxiety symptoms and subsequent cognitive decline.


We included 2,818 community-dwelling older men (mean age = 76.1, SD ±5.3 years) who were followed on an average for 3.4 years. We assessed anxiety symptoms at baseline using the Goldberg Anxiety Scale (GAS; range = 0–9). We assessed cognitive function at baseline and at two subsequent visits using the Modified Mini-Mental State Examination (3MS; global cognition) and the Trails B test (executive function).


At baseline, there were 690 (24%) men with mild anxiety symptoms (GAS 1–4) and 226 (8%) men with moderate/severe symptoms (GAS 5–9). Men with anxiety symptoms were more likely to have depressed mood, poor sleep, more chronic medical conditions, and more impairment in activities of daily living compared to those with no anxiety symptoms. Compared to those with no anxiety symptoms at baseline, men with any anxiety symptoms were more likely to have substantial worsening in Trails B completion time (OR = 1.56, 95% CI 1.19, 2.05). The association was attenuated after adjusting for potential confounders, including depression and poor sleep, but remained significant (OR = 1.40, 95% CI 1.04, 1.88).


In cognitively healthy older men, mild anxiety symptoms may potentially predict future decline in executive functioning. Anxiety is likely a manifestation of an underlying neurodegenerative process rather than a cause.


Corresponding author

Correspondence should be addressed to: Jane A. Cauley, DrPH, Department of Epidemiology, University of Pittsburgh, 130 DeSoto Street, A510 Crabtree Hall, Pittsburgh, Pennsylvania, USA. Phone: 412-624-3057; Fax: 412-624-7397. Email:


Hide All
Andreescu, C., Teverovsky, E., Fu, B., Hughes, T. F., Chang, C. C. and Ganguli, M. (2014). Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. American Journal of Geriatric Psychiatry, 22, 274284.
Andrew, M. K. and Rockwood, K. (2008). A five-point change in modified mini-mental state examination was clinically meaningful in community-dwelling elderly people. Journal of Clinical Epidemiology, 61, 827831.
Baxter, A. J., Vos, T., Scott, K. M., Ferrari, A. J. and Whiteford, H. A. (2014). The global burden of anxiety disorders in 2010. Psychological Medicine, 44, 23632374.
Beaudreau, S. A. and O'Hara, R. (2008). Late-life anxiety and cognitive impairment: a review. American Journal of Geriatric Psychiatry, 16, 790803.
Bierman, E. J., Comijs, H. C., Rijmen, F., Jonker, C. and Beekman, A. T. (2008). Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam. Aging Ment Health, 12, 517523.
Billioti de Gage, S. et al. (2012). Benzodiazepine use and risk of dementia: prospective population based study. BMJ, 345, e6231.
Blackwell, T. et al. (2014). Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep, 37, 655663.
Blank, J. B. et al. (2005). Overview of recruitment for the osteoporotic fractures in men study (MrOS). Contemporary Clinical Trials, 26, 557568.
Burton, C., Campbell, P., Jordan, K., Strauss, V. and Mallen, C. (2013). The association of anxiety and depression with future dementia diagnosis: a case-control study in primary care. Family Practice, 30, 2530.
Buysse, D. J., Reynolds, C. F. 3rd, Monk, T. H., Berman, S. R. and Kupfer, D. J. (1989). The Pittsburgh Sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193213.
Byers, A. L. and Yaffe, K. (2011). Depression and risk of developing dementia. Nature Reviews: Neurology, 7, 323331.
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B. and Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication. Archives of General Psychiatry, 67, 489496.
Cherbuin, N. et al. (2009). Risk factors of transition from normal cognition to mild cognitive disorder: the PATH through life study. Dementia and Geriatric Cognitive Disorders, 28, 4755.
de Bruijn, R. F. et al. (2014). Anxiety is not associated with the risk of dementia or cognitive decline: the Rotterdam Study. American Journal of Geriatric Psychiatry, 22, 13821390.
Gallacher, J. et al. (2009). Does anxiety affect risk of dementia? Findings from the caerphilly prospective study. Psychosomatic Medicine, 71, 659666.
Gallagher, D. et al. (2011). Anxiety and behavioural disturbance as markers of prodromal Alzheimer's disease in patients with mild cognitive impairment. International Journal of Geriatric Psychiatry, 26, 166172.
Ganguli, M. (2009). Depression, cognitive impairment and dementia: why should clinicians care about the web of causation? Indian Journal of Psychiatry, 51 (Suppl. 1), S29S34.
Ganguli, M. et al. (1993). Sensitivity and specificity for dementia of population-based criteria for cognitive impairment: the MoVIES project. Journal of Gerontology, 48, M152M161.
Goldberg, D., Bridges, K., Duncan-Jones, P. and Grayson, D. (1988). Detecting anxiety and depression in general medical settings. BMJ, 297, 897899.
Gum, A. M., King-Kallimanis, B. and Kohn, R. (2009). Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. American Journal of Geriatric Psychiatry, 17, 769781.
Kuller, L. H. et al. (2003). Risk factors for dementia in the cardiovascular health cognition study. Neuroepidemiology, 22, 1322.
Lopez, O. L. et al. (2003). Psychiatric symptoms vary with the severity of dementia in probable Alzheimer's disease. Journal of Neuropsychiatry and Clinical Neurosciences, 15, 346353.
Mantella, R. C. et al. (2007). Cognitive impairment in late-life generalized anxiety disorder. American Journal of Geriatric Psychiatry, 15, 673679.
Orwoll, E. et al. (2005). Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study – a large observational study of the determinants of fracture in older men. Contemporary Clinical Trials, 26, 569585.
Pachana, N. A., Byrne, G. J., Siddle, H., Koloski, N., Harley, E. and Arnold, E. (2007). Development and validation of the geriatric anxiety inventory. International Psychogeriatrics, 19, 103114.
Pahor, M., Chrischilles, E. A., Guralnik, J. M., Brown, S. L., Wallace, R. B. and Carbonin, P. (1994). Drug data coding and analysis in epidemiologic studies. European Journal of Epidemiology, 10, 405411.
Paterniti, S., Dufouil, C. and Alperovitch, A. (2002). Long-term benzodiazepine use and cognitive decline in the elderly: the epidemiology of vascular aging study. Journal of Clinical Psychopharmacology, 22, 285293.
Pietrzak, R. H. et al. (2012). Mild worry symptoms predict decline in learning and memory in healthy older adults: a 2-year prospective cohort study. American Journal of Geriatric Psychiatry, 20, 266275.
Plassman, B. L. et al. (2007). Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology, 29, 125132.
Potvin, O., Forget, H., Grenier, S., Preville, M. and Hudon, C. (2011). Anxiety, depression, and 1-year incident cognitive impairment in community-dwelling older adults. Journal of the American Geriatrics Society, 59, 14211428.
Reitan, R. and Wolfson, D. (1985). The Halstead-Reitan Neuropsychological Battery: Theory and Clinical Interpretation. Tuscon, AZ: Neuropsychology Press.
Sheikh, J. and Yesavage, J. (1986). Geriatric depression scale: recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165173.
Sinoff, G. and Werner, P. (2003). Anxiety disorder and accompanying subjective memory loss in the elderly as a predictor of future cognitive decline. International Journal of Geriatric Psychiatry, 18, 951959.
Teng, E. L. and Chui, H. C. (1987). The modified mini-mental state (3MS) examination. Journal of Clinical Psychiatry, 48, 314318.
van Hout, H. P. et al. (2004). Anxiety and the risk of death in older men and women. British Journal of Psychiatry, 185, 399404.
Washburn, R. A., Smith, K. W., Jette, A. M. and Janney, C. A. (1993). The physical activity scale for the elderly (PASE): development and evaluation. Journal of Clinical Epidemiology, 46, 153162.
Wolitzky-Taylor, K. B., Castriotta, N., Lenze, E. J., Stanley, M. A. and Craske, M. G. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety, 27, 190211.
Yaffe, K. and Boustani, M. (2014). Benzodiazepines and risk of Alzheimer's disease. BMJ, 349, g5312.
Yochim, B. P., Mueller, A. E. and Segal, D. L. (2013). Late life anxiety is associated with decreased memory and executive functioning in community dwelling older adults. Journal of Anxiety Disorders, 27, 567575.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed