Regular Research Article
Phobic Anxiety and Cognitive Performance Over 4 Years Among Community-Dwelling Older Women in the Nurses' Health Study

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Objective

To examine the relation of phobic anxiety to late-life cognitive trajectory.

Design

Prospective cohort.

Setting

Nurses' Health Study—U.S. registered nurses.

Participants

A total of 16,351 women among whom phobic anxiety symptoms were assessed in 1988 (mean age = 63 years).

Measurements

Beginning a decade after phobic anxiety ascertainment (mean age = 74 years), three assessments of general cognition, word and paragraph immediate and delayed recall, category fluency, and attention or working memory were administered over an average of 4.4 years; global cognitive and verbal memory composite scores were generated from the component tests. General linear models of response profiles were used to evaluate relations of phobic anxiety to initial cognitive performance and subsequent change.

Results

Higher phobic anxiety was associated with poorer initial performance: for example, comparing women with the highest anxiety to those with no or minimal symptoms, the multivariate-adjusted mean difference (95% confidence interval) in scores was −0.10 (−0.13,−0.06) standard units for the global score summarizing all tests, and −0.08 (−0.11,−0.04) standard units for verbal memory (summarizing four word- and paragraph-recall tasks). Mean differences between extreme categories of phobic anxiety were equal to those for participants aged 1.5–2 years apart: that is, cognitively equivalent to being about 2 years older. There were no relations of phobic anxiety to subsequent cognitive change.

Conclusions

Higher mid-life phobic anxiety was related to worse later-life overall cognition and verbal memory. Yet, profiles of poorer cognition with higher anxiety remained parallel over time, suggesting phobic anxiety may impose impact on cognition earlier in life, rather than ongoing impact in later-life.

Section snippets

Study Sample

The Nurses' Health Study (NHS) included 121,700 U.S. woman registered nurses, age 30–55 at the study's inception in 1976. Since then, participants have completed biennial mailed questionnaires updating information on lifestyle factors and health outcomes; total follow-up >90%. On the 1988 follow-up questionnaire, participants were asked to complete the phobic anxiety scale of the Crown–Crisp Index (CCI).15 Subsequently, between 1995 and 2001, NHS participants age 70 and older, and free of

Results

Table 1 shows characteristics of the study sample in 1988 across phobic anxiety levels. Women in the highest phobic category were generally less healthy than those in the lowest phobic category: for example, higher phobic anxiety was associated with higher BMI, higher prevalence of severe depressive symptoms, hypertension, heart disease, diabetes, elevated cholesterol and current smoking, and lower physical activity. Another notable difference was the pattern of lower educational attainment

Discussion

In this study of 16,351 community-dwelling older women, we observed modest but statistically significant associations between higher mid-life levels of phobic anxiety, measured by a validated symptom scale, and worse later-life performance in overall cognitive function and in verbal memory. Specifically, being in the highest phobic anxiety category was cognitively equivalent to almost 2 years of aging. Associations remained statistically significant after adjustment for depression and numerous

Conclusion

In conclusion, higher mid-life phobic anxiety was related to worse later-life cognition in this study of over 16,000 women; these associations were modest (cognitively equivalent to 1.5–2 years of age) but statistically significant. Yet, profiles of poorer cognitive performance with higher phobic anxiety remained parallel over time. Thus, while anxiety may be related to worse initial cognition, we found no evidence that it is associated with continued decline throughout laterlife. Our results

References (40)

  • J.L. Wetherell et al.

    Anxiety, cognitive performance, and cognitive decline in normal aging

    J Gerontol B Psychol Sci Soc Sci

    (2002)
  • R.S. Wilson et al.

    Proneness to psychological distress is associated with risk of Alzheimer's disease

    Neurology

    (2003)
  • M. Jelicic et al.

    Neuroticism does not affect cognitive functioning in later life

    Exp Aging Res

    (2003)
  • E.J. Bierman et al.

    Anxiety symptoms and cognitive performance in later life: results from the longitudinal aging study Amsterdam

    Aging Ment Health

    (2008)
  • M.J. Engelhart et al.

    Inflammatory proteins in plasma and the risk of dementia: the Rotterdam study

    Arch Neurol

    (2004)
  • K. Yaffe et al.

    Inflammatory markers and cognition in well-functioning African American and white elders

    Neurology

    (2003)
  • A.M. Brennan et al.

    Phobic anxiety is associated with higher serum concentrations of adipokines and cytokines in women with diabetes

    Diabetes Care

    (2009)
  • C.M. Albert et al.

    Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women

    Circulation

    (2005)
  • R.C. Kessler et al.

    Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication

    Arch Gen Psychiatry

    (2005)
  • S. Crown et al.

    A short clinical diagnostic self-rating scale for psychoneurotic patients. The Middlesex Hospital Questionnaire (M.H.Q.)

    Br J Psychiatry

    (1966)
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