Anxiety is not associated with the risk of dementia or cognitive decline: the Rotterdam Study

Renée F A G de Bruijn; Nese Direk; Saira Saeed Mirza; Albert Hofman; Peter J Koudstaal; Henning Tiemeier; M Arfan Ikram

doi:10.1016/j.jagp.2014.03.001

Anxiety is not associated with the risk of dementia or cognitive decline: the Rotterdam Study

Am J Geriatr Psychiatry. 2014 Dec;22(12):1382-90. doi: 10.1016/j.jagp.2014.03.001. Epub 2014 Mar 15.

Authors

Renée F A G de Bruijn¹, Nese Direk², Saira Saeed Mirza², Albert Hofman², Peter J Koudstaal³, Henning Tiemeier⁴, M Arfan Ikram⁵

Affiliations

¹ Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands.
² Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
³ Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
⁴ Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands.
⁵ Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Netherlands Consortium for Healthy Ageing, Leiden, The Netherlands. Electronic address: m.a.ikram@erasmusmc.nl.

PMID: 24745561
DOI: 10.1016/j.jagp.2014.03.001

Abstract

Objective: Anxiety and depression frequently co-occur in the elderly and in patients with dementia. Prior research has shown that depression is related to the risk of dementia, but the effect of anxiety on dementia remains unclear. We studied whether anxiety symptoms and anxiety disorders are associated with the risk of dementia and cognition.

Methods: We studied 2,708 nondemented participants from the prospective, population-based Rotterdam Study who underwent the Hospital Anxiety and Depression Scale (HADS) (sample I, baseline 1993-1995) and 3,069 nondemented participants who underwent screening for anxiety disorders (sample II, baseline 2002-2004). In 1993-1995, anxiety symptoms were assessed using the HADS. In 2002-2004, anxiety disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In both study samples, participants were continuously monitored for dementia until January 1, 2011. Cognition was tested in 2002-2004 and at a follow-up visit in 2009-2011 in sample II only.

Results: In sample I, 358 persons developed dementia, and in sample II, 248 persons developed dementia. We did not find an association with the risk of dementia for anxiety symptoms (hazard ratio 1.05, 95% confidence interval: 0.77-1.43, Wald statistic 0.08, p = 0.77, df = 1) or for anxiety disorders (hazard ratio 0.92, 95% confidence interval: 0.58-1.45, Wald statistic 0.14, p = 0.71, df = 1). We could demonstrate an association of anxiety disorders with poor cognition cross-sectionally, but this attenuated after additional adjustments.

Conclusion: Our findings do not offer evidence for an association between anxiety symptoms or anxiety disorders with the risk of dementia or with cognition. This suggests that anxiety is not a risk factor nor a prodrome of dementia in an elderly, community-dwelling population.

Keywords: Epidemiology; anxiety disorders; anxiety symptoms; cognition; dementia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Anxiety / diagnosis
Anxiety / epidemiology*
Anxiety Disorders / diagnosis
Anxiety Disorders / epidemiology*
Cognition Disorders / diagnosis
Cognition Disorders / epidemiology*
Dementia / diagnosis
Dementia / epidemiology*
Female
Humans
Male
Middle Aged
Netherlands / epidemiology
Prospective Studies
Risk