More than 55 million people worldwide have dementia, a number that is expected to rise to 139 million by 2050. With the condition also a leading cause of death, researchers and health professionals have focused on prevention, especially by addressing risk factors such as anxiety or lifestyle habits.
Previous studies exploring the relationship between anxiety and dementia have largely measured participants’ anxiety at a specific point in time, yielding varying conclusions — but the duration of someone’s anxiety is an important aspect to consider, the authors argued.
The team studied 2,132 participants recruited from the Newcastle-based Hunter Community Study between December 2004 and December 2007. They were aged 60 to 81 or older, and at the start of the study provided health data such as tobacco use or alcohol consumption, or whether they had conditions such as high blood pressure or diabetes.
There were three assessments, also called waves, five years apart. Researchers measured participants’ anxiety at the first and second assessments. Chronic anxiety was defined as the presence of anxiety at both the first and second waves. Someone’s anxiety was considered resolved if they had anxiety only at the time of the first wave. New-onset anxiety refers to anxiety identified only at the second wave.
Dementia was identified using International Classification of Diseases codes or pharmaceutical benefits data showing the purchase of dementia medications, provided by the Australian Department of Health and Aged Care.
In the end, 64 participants developed dementia. Chronic anxiety and new anxiety were associated with a nearly threefold increased risk of dementia from any cause — with a median time to diagnosis of 10 years, the authors found.
Anxiety that resolved within the first five years was not associated with a higher risk, with the odds being similar to those without anxiety — a finding that Glen R. Finney, a fellow of the American Academy of Neurology, called “a welcome addition to our knowledge about anxiety and dementia.” Finney, director of the Memory and Cognition Program at Geisinger in Pennsylvania, was not involved in the study.
The results were also largely driven by participants under 70 years old.
“We have long known that stress increases the risk of Alzheimer’s disease,” Rudolph Tanzi, director of the McCance Center for Brain Health at Massachusetts General Hospital in Boston, who was not involved in the study, said in an email. “This study agrees with previous studies that therapy aimed at alleviating anxiety may help reduce the risk of Alzheimer’s disease. But it is the size of this study that is particularly compelling.”
The authors of the latest study had no information about what helped some participants overcome their anxiety.
The findings highlight “the importance of treating anxiety early and consistently,” said neurologist Joel Salinas, founder and chief medical officer of Isaac Health, a virtual and home-based clinical service for dementia and other brain health conditions. Salinas was not involved in the research.
Stress and neurodegenerative disease
The study has some limitations, including the fact that measures of participants’ anxiety were based on the four weeks prior to the assessments, the authors said. The team also missed 33 percent of participants who had higher levels of anxiety at the start of the study; not knowing what happened to these people could result in an underestimation of the effect of anxiety on dementia.
“In the future,” says Finney, “it would be useful to follow up the findings with a prospective study using cognitive and biological measures of stress hormones, inflammation, and neurodegeneration, including for Alzheimer’s disease.”
The association between anxiety and dementia may be partly explained by the former’s link to vascular disease — a cause of dementia — and harmful effects on cells, experts say.
Stress increases cortisol in the brain and inflammation, both of which kill nerve cells, says Tanzi, who is also director of the genetics and aging research unit at Massachusetts General Hospital.
Anxiety is also associated with the buildup of beta-amyloid, according to Khaing, which is a hallmark of Alzheimer’s disease.
The disorder has also been linked to structural changes in the brain “such as cerebral and hippocampal atrophy, all processes that are also associated with dementia,” Khaing adds. Atrophy refers to the wasting away of a tissue or organ, especially as a result of cellular degeneration.
However, the study “may also suggest the possibility that anxiety may be an early manifestation of an underlying brain disease,” Salinas, a clinical assistant professor of neurology at NYU Langone Health, says in an email. “Someone’s early cognitive decline may contribute to their anxiety (e.g., making mistakes or feeling embarrassed in social situations).”
At the start of the study, the authors excluded people who already had cognitive impairment, but acknowledged that undetected decline is still possible.
People with anxiety are also more likely to make unhealthy choices, such as having a poor diet or smoking, the authors said.
Anxiety management
Anxiety is a normal response to stressors, but if it’s excessive, “seek help,” says Khaing.
Talk to your doctor or a mental health professional about your options, which may include lifestyle changes such as stress management, a healthy diet, exercise, and better sleep, all of which also separately influence dementia risk, experts say. Important forms of treatment also include different types of therapy or antidepressant medications.
“But I recommend avoiding certain medications that harm the brain, including tricyclic antidepressants, benzodiazepines, and strong antihistamines,” says Finney.
Cognitive behavioral therapy is the treatment of choice for many anxiety disorders. It works by uncovering “unhealthy thought patterns and how they may be causing self-defeating behaviors and beliefs,” according to the National Alliance on Mental Illness.
Additionally, “try adopting a meditation practice and limiting expectations of others and yourself when responding to emails, texts, and social media,” Tanzi says. “We also recommend avoiding people you really don’t like and interacting with those who have a positive effect… on your well-being.”
Tanzi emphasized that anxiety is a result of the “oldest, most primitive parts” of our brain, which are focused solely on survival.
“It’s important to always try to be aware and mindful if your brain is pushing you to overemphasize these survival needs,” he says.
Source: CNN Brasil
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