Anxiety has been linked to an increased rate of progression from mild cognitive impairment to Alzheimer’s disease, according a new US study.
Dementia, including Alzheimer’s, is the second leading cause of death for both men and women in Australia.
Around 460,000 Australians currently live with dementia in one form or another. That number is expected to increase to 1.1 million by 2058.
It has been labelled by Dementia Australia chief Maree McCabe as “the chronic disease of the 21st century”.
The number of Alzheimer’s deaths worldwide has doubled since 2000.
Anxiety is the most common mental health condition in Australia.
“In a 12-month period, over two million Australians experience anxiety.”
Feelings of worry, anxiety or fear strong enough to interfere with daily activities are common indicators of an anxiety disorder, which can lead to panic attacks, obsessive-compulsive disorder and post-traumatic stress disorder.
Symptoms include stress that’s out of proportion to the impact of the event, inability to set aside a worry and restlessness.
Anxiety is frequently observed in people with mild cognitive impairment. While its role in disease progression is not well understood, researchers from the Medical University of South Carolina (MUSC) have discovered that patients with mild cognitive impairment and anxiety developed Alzheimer’s disease at a much faster rate than those without anxiety.
“We know that volume loss in certain areas of the brain is a factor that predicts progression to Alzheimer’s disease,” said study senior author Professor Maria Vittoria Spampinato.
“In this study, we wanted to see if anxiety had an effect on brain structure, or if the effect of anxiety was independent from brain structure in favouring the progression of disease.”
The study involved 339 patients with an average age of 72 years and each with a baseline diagnosis of mild cognitive impairment.
Of this group, 72 progressed to Alzheimer’s disease and 267 remained stable.
Using brain MRIs, the researchers studied the hippocampus and the entorhinal cortex – the two brain areas most important to forming memories.
They looked for the presence of the ApoE4 allele, the most prevalent genetic risk factor for Alzheimer’s disease.
Patients with Alzheimer’s disease had significantly lower volumes in the hippocampus and the entorhinal cortex and greater frequency of the ApoE4 allele.
Anxiety levels established by clinical surveys were independently associated with cognitive decline.
“Mild cognitive impairment patients with anxiety symptoms developed Alzheimer’s disease faster than individuals without anxiety, independently of whether they had a genetic risk factor for Alzheimer’s disease or brain volume loss,” said study first author Jenny L. Ulber.
Learning more about how anxiety symptoms lead to a faster progression to Alzheimer’s disease can help specialists better manage patients with early mild cognitive impairment.
“We need to better understand the association between anxiety disorders and cognitive decline,” said Prof. Spampinato.
“We don’t know yet if the anxiety is a symptom – in other words, their memory is getting worse and they become anxious – or if anxiety contributes to cognitive decline. If we were able in the future to find that anxiety is actually causing progression, then we should more aggressively screen for anxiety disorders in the elderly.”
“The geriatric population is routinely screened for depression in many hospitals, but perhaps this vulnerable population should also be assessed for anxiety disorders,” added Ms Ulber.
“Middle-aged and elderly individuals with high level of anxiety may benefit from intervention, whether it be pharmacological or cognitive behavioural therapy, with the goal of slowing cognitive decline.”
The team hopes further study will help them better understand the connection between anxiety and brain structure.
“We’re now interested in looking at changes over time to see if anxiety has an effect one way or the other on how fast the brain damage progresses,” said Prof. Spampinato.
“We will also take a closer look at gender differences in the association between anxiety and cognitive decline.”
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Disclaimer: Australian readers seeking support and information about suicide and depression can contact Lifeline on 13 11 14. For more information on treating depression and anxiety, please visit Beyond Blue.