Anxiety Goes Beyond Stress – It Can Speed Up Alzheimer’s

Anxiety can do more than augment daily stress levels. New research with brain MRIs shows it is also associated with a faster transition from mild cognitive impairment to Alzheimer’s disease.

Deaths associated with Alzheimer’s disease have more than doubled since 2000, and many of these individuals start down the path by suffering mild symptoms, such as declines in memory and thinking skills. Many also exhibit signs of anxiety, but little is known about the role anxiety might actually play in cognitive decline.

In research that will be presented next week during the Radiological Society of North America (RSNA) annual meeting, investigators from the Medical University of South Carolina (MUSC) explored that question.

“We know that volume loss in certain areas of the brain is a factor that predicts progression to Alzheimer’s disease,” said senior study author Maria Vittoria Spampinato, M.D., MUSC radiology professor. “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 favoring the progression of disease.”

To get a better understanding of the impact of anxiety, Spampinato’s team examined brain MRI scans of 339 patients included in the Alzheimer’s Disease Neuroimaging Initiative 2 cohort. The average age was 72, and each patient had a baseline diagnosis of mild cognitive impairment. Of the group, 72 progressed to Alzheimer’s and the remaining 267 stayed cognitively stable.

Using these scans, the team identified baseline hippocampus and entorhinal cortex volumes. These areas are integral to forming memories, they said. In addition, they tested study participants for the presence of the ApoE4 allele, the most prevalent genetic risk factor for Alzheimer’s disease. For anxiety measurements and assessments, they conducted clinical surveys.

Their evaluation confirmed some expectations. Patients who progressed through to Alzheimer’s did, indeed, have significantly lower hippocampus and entorhinal cortex volumes, as well as a greater incidence of the ApoE4 allele.

The team also made an additional discovery – anxiety was independently associated with cognitive decline. Those study participants with anxiety symptoms did progress to Alzheimer’s faster regardless of whether they had the ApoE4 allele or had brain volume loss. Being able to identify this link, they said, opens the door to improving how patients with mild cognitive impairment are screened and managed.

“We need to better understand the association between anxiety disorders and cognitive decline,” Spampinato said. “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.”

For example, said Jenny L. Ulber, MUSC medical student and first author, it could be helpful to conduct an assessment for anxiety disorders alongside the depression evaluations completed on elderly patients who are in the hospital.

“Middle-aged and elderly individuals with high levels of anxiety may benefit from intervention,” she said, “whether it be pharmacological or cognitive behavior therapy, with the goal of slowing cognitive decline.”

Their study did have a limitation of relying on MRI scans conducted at one moment in time. For future work – and to continue to better understand this link between anxiety and brain structure – the team plans to study MRIs collected after initial scans.

“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,” Spampinato said. “We will also take a closer look at gender differences in the association between anxiety and cognitive decline.”

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