Neuropsychological Correlates of Anxiety in Older Adults: A Cross-Sectional Comparison with Controls Without a Psychiatric Diagnosis

Abstract

Highlights What are the main findings? Older adults in the anxiety group showed selective difficulties in memory, attention, processing speed, and executive functioning despite normal global cognitive screening results. An anxiety-related clinical diagnosis showed a more consistent independent association with cognitive performance than anxiety symptom severity as measured by the GAS total score, alongside education, age, and depressive symptom burden. What are the implications of the main findings? Global screening tools alone may be insufficient to identify cognitive difficulties associated with late-life anxiety, and domain-specific cognitive assessment may provide additional information. Clinicians should consider that cognitive difficulties associated with late-life anxiety may not be fully reflected by anxiety symptom severity alone, and domain-specific cognitive assessment may provide additional information beyond global screening tools. Abstract Background/Objectives: Anxiety symptoms are common in older adults and are associated with cognitive changes; however, the specific pattern of deficits and the effects of anxiety diagnosis, symptom severity, and depressive symptoms remain unclear. This study compared cognitive performance between older adults with anxiety-related diagnoses and psychiatrically healthy controls and examined factors associated with cognitive outcomes. Methods: This cross-sectional study included 130 participants aged ≥ 65 years: 70 with an anxiety-related diagnosis (SCID-5-CV) and 60 controls without psychiatric diagnoses. Cognition was assessed using the SMMSE, Enhanced Cue Recall Test, Clock Drawing Test, Verbal Fluency Test, and Trail Making Test Parts A and B; anxiety and depressive symptoms were assessed with validated scales. Results: The anxiety group had higher anxiety and depression scores than controls (FDR-adjusted q < 0.001). They showed longer Trail Making Test A, B, and B–A times and lower free recall and enhanced cue recall scores (q = 0.019 and q < 0.001, respectively). No differences were observed in global cognition, clock drawing, or verbal fluency after correction. Most symptom–cognition correlations did not survive Bonferroni correction, except for state anxiety and enhanced cue recall. In regression analyses, anxiety-related diagnosis showed a more consistent association with cognition than anxiety symptom severity, along with education, age, gender, and depressive symptoms. Conclusions: Older adults with anxiety-related diagnoses showed selective impairments in processing speed, attention, executive functions, and memory despite preserved global cognitive screening. Cognitive outcomes in late-life anxiety appear more closely related to diagnostic status and other clinical/demographic factors than to anxiety severity alone.