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Anxiety in midlife linked to risk of later dementia

GPs could consider it alongside depression as an indicator of risk for dementia, say researchers

Louise Prime

Tuesday, 01 May 2018

Clinically significant anxiety in midlife was associated with an increased risk of dementia over an interval of at least 10 years, according to a new study* whose authors said their findings indicate that anxiety might be a risk factor for late-life dementia. They pointed out in BMJ Open that it remains ‘an open question’ whether or not reducing anxiety in middle age would result in a reduced risk of dementia – the effect of drug and non-drug treatment of anxiety during midlife on later risk for dementia has not yet been investigated – but they suggested that, given the prevalence of anxiety, GPs could consider it alongside depression as an indicator of risk for dementia.

The researchers, led from the University of Southampton and University College London, conducted a systematic review of the literature on anxiety diagnosis and long-term risk for dementia, and found 18 potentially eligible studies; after excluding 14 for methodological reasons, they were left with four high-quality studies to review, with a combined population of 29,819.

They reported that all studies in the review found a significant increase in the number of dementia diagnoses in patients who had a clinical anxiety diagnosis or experienced clinically significant anxiety symptoms on average at least 10 years prior to their diagnosis of dementia; but the size of the increase in risk varied considerably between studies. They noted that, on the whole, retrospective studies that looked back for lifelong diagnoses of anxiety found a stronger association between midlife anxiety and later dementia diagnosis than prospective studies investigating an association over a shorter time period.

The study authors added that all four studies controlled for demographic factors as well as vascular and other psychiatric risk factors; and all assessed and controlled for depression symptoms. Two of the studies had findings that supported the associations being independent of prodromal dementia symptoms.

They said: “Whether reducing anxiety in middle age would result in reduced risk of dementia remains an open question. The effect of treatment of anxiety using pharmacological and non-pharmacological therapies during midlife on later risk for dementia has not yet been investigated.”

They pointed out that benzodiazepines could not be considered, as they have been shown to increase risk of mortality in some groups; but non-pharmacological therapies, including talking therapies and mindfulness-based interventions and meditation practices, might have a risk-reducing effect – though this needs more thorough research.

They concluded: “Given the high prevalence of anxiety seen in primary care, we suggest that general practitioners could consider anxiety alongside depression as an indicator of risk for dementia. To improve the rate of earlier diagnosis of dementia, close monitoring of subtle cognitive decline in older adults with a history of anxiety, depression and cerebrovascular disease would be encouraged.”

*Gimson A, Schlosser M, Huntley JD, et al. Support for midlife anxiety diagnosis as an independent risk factor for dementia: a systematic review. BMJ Open 2018; 8: e019399. doi 10.1136/bmjopen-2017-019399

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