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Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety.
Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD).
After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs.
These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.
Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues.
The present study was conducted to determine whether anxiety among community-dwelling elders is associated with cognitive decline over a period of one year as well as to verify whether there are sex differences in the association between anxiety and cognitive decline. Participants (n=1942) were community-dwelling adults aged 65–96 years assessed at study entry (T0) and one year later (T1). Anxiety was identified with a semi-structured interview and cognitive functioning was assessed using the Mini-Mental State Examination. Results revealed that the presence of a clinically significant anxiety disorder did not predict cognitive decline in men and women. Subclinical anxiety symptoms predicted cognitive decline in women only. Moreover, for men, the presence of symptoms from at least two anxiety disorders predicted cognitive decline. For women, cognitive decline was predicted by the presence of symptoms from one anxiety disorder only. Overall, the results illustrate the role of anxiety in cognitive decline in community-dwelling older adults.
Background: The objectives of this study were to examine the factors modifying the relationship between cortisol level and prevalent/incident cognitive impairment in older adults and to verify whether these relationships were non-linear.
Methods: Data were collected from 1,226 individuals aged 65 and older by two in-home interviews separated by 12 months. Cortisol level was measured using saliva samples taken at the beginning of the baseline interview before cognitive, mental, and physical health evaluations. Prevalent and incident cognitive impairment were defined using the Mini-Mental State Examination scores according to normative data for age, education level, and sex.
Results: High morning cortisol level increased the risk of incident cognitive impairment in participants with anxiety or depressive episode while low cortisol level increased the risk in participants without anxiety or depressive episode. In high educated participants, but not in low educated participants, high morning cortisol level was associated with prevalent cognitive impairment and high afternoon cortisol level increased the risk of incident cognitive impairment. The results also suggested that lower morning cortisol values could increase the risk of incident cognitive impairment in individuals with few chronic diseases. A curvilinear relationship was observed between morning cortisol and the probability of incident cognitive impairment, but further analyses suggested that it was likely explained by anxiety and depressive episode.
Conclusions: These results suggest that cognitive impairment in older adults is linked to higher or lower cortisol level depending on characteristics such as anxiety, depressive episode, education level, and physical health.
Background: Whereas the State-Trait Anxiety Inventory (STAI-Y) is probably the most widely used self-reported measure of anxiety, the lack of current norms among elderly people appears to be problematic in both a clinical and research context. The objective of the present study was to provide normative data for the STAI-Y trait scale from a large elderly cohort and to identify the main sociodemographic and health-related determinants of trait anxiety.
Methods: The STAI-Y trait scale was completed by 7,538 community-dwelling participants aged 65 years and over from the “Three City” epidemiological study. Trained nurses and psychologists collected information during a face-to-face interview including sociodemographic characteristics and clinical variables.
Results: The scale was found to have good internal consistency (Cronbach's α = 0.89). Norms were stratified for gender and educational level differentiating persons with and without depressive symptoms. Multivariate linear regression found the STAI-Y trait score to be significantly associated with female gender, psychotropic medication use, higher depressive symptoms, higher cognitive complaints, and with an interaction between subjective health and marital status. Age was not associated with the total score.
Conclusion: This study provides norms for the STAI-Y trait scale in the general elderly population which are of potential use in both a clinical and research context. The present results confirm the importance of several factors previously associated with higher trait anxiety in the elderly. However, more research is needed to better understand the clinical specificities of anxiety in the elderly and the improvement of assessment.
Background: The latest version of the State-Trait Anxiety Inventory (STAI-Y) is commonly used in older adults, even though this anxiety scale was developed in and for young adults. Norms and associated factors of the STAI-Y are lacking for older adults in the general population. The objectives of the present study were to produce norms on the STAI-Y State scale for older adults using a large sample of older adults selected from a general population and to examine the sociodemographic and health-related factors associated with the STAI-Y State score.
Methods: 993 community-dwelling individuals aged 66 years and over from the PAQUID study were evaluated at home by a psychologist for the following variables: age, education, marital status, proximity of relatives, self-assessment of income sufficiency, occupation during active life, depressive symptomatology, objective and subjective health, objective and subjective cognitive functioning, adverse life events, activities of daily living, drug use, and cigarette consumption.
Results: Norms were stratified for age, sex, and education and were produced separately for older adults with and without depressive symptomatology. Multivariate analyses revealed that younger age (66–79 years), female sex, lower education, perception of income insufficiency, depressive symptomatology, poor subjective health, subjective cognitive complaints, psychotropic drugs use, and recent adverse life events were independently associated with higher STAI-Y State score.
Conclusions: This study provides norms for the STAI-Y State anxiety inventory in a general population of older adults and indicates the specific factors linked with state anxiety. Such factors should be taken into account by clinicians in order to better understand state anxiety in older adults.
Background: Several neuropsychiatric symptoms observed in elders with cognitive impairment no dementia (CIND) can be part of a major depressive episode (MDE) or a “subthreshold” depressive episode. Certain neuropsychiatric symptoms of CIND are essential symptoms of MDE (e.g. dysphoria, anhedonia), while other are non-essential symptoms (NESD; e.g. fatigue, insomnia, cognitive complaint). Contrary to essential symptoms, NESD are not specific to MDE and are present in other disorders. It is unknown whether NESD are linked to CIND in absence of MDE or subthreshold MDE. The present study examined the association between NESD and probable CIND in elders without essential MDE symptoms.
Methods: Participants were 2028 community-dwelling individuals aged 65–96 years who had not experienced dysphoria/anhedonia during the year preceding the interview. Semi-structured in-home interviews evaluated the following NESD: alteration of appetite, sleep disturbance, psychomotor alteration, fatigue/loss of energy, worthlessness/guilt, and cognitive complaints. Probable CIND cases were defined based on the Mini-mental State Examination cut-offs (15th percentile) stratified for age, education and sex.
Results: Symptoms of fatigue/loss of energy (OR: 2.41, 95% CI: 1.42–4.09), sleep disturbance (OR: 3.04 CI: 1.69–5.46) and cognitive complaints (OR: 2.86 CI: 1.71–4.77) were significantly associated with CIND. These associations were not modified after adjustments for potential confounders (age, education level, sex, benzodiazepine use, chronic diseases, and brain disorders).
Conclusion: A psychiatric symptomatology occurs in older adults with CIND in the absence of MDE or subthreshold MDE. NESD encountered in the absence of dysphoria/anhedonia should receive particular attention by clinicians since they can be linked to cognitive difficulties.
This study was aimed at providing normative data for the Mini-Mental State Examination (MMSE). The norms were built from a sample (n = 2409) of community-dwelling French speaking residents from Québec aged 65 and older. The analyses indicated that socio-demographic variables such as education level, age, and gender of individuals influenced significantly the scores of older adults on the MMSE. More precisely, MMSE scores increased with education level and decreased with age. Moreover, women had significantly higher scores than men. On this basis, distinct tables of normative data were produced for women and men. In each table, the MMSE scores corresponding to percentiles 5, 10, 15 and 50 were identified according to four age categories and three education levels. Overall, the use of the present normative data by clinicians will improve their accuracy in detecting cognitive impairment in older adults from Québec.
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