Anxiety, Depression, and 1-Year Incident Cognitive Impairment in Community-Dwelling Older Adults

OBJECTIVES: To examine in men and women the independent associations between anxiety and depression and 1-year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1-year incident anxiety or depression. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population-based sample of 1,942 individuals aged 65 to 96. MEASUREMENTS: Two structured interviews 12 months apart evaluated anxiety and mood symptoms and disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Incident cognitive impairment was defined as no CIND at baseline and a follow-up Mini-Mental State Examination score at least 2 points below baseline and below the 15th percentile according to normative data. The associations between cognitive impairment and anxiety or depression were assessed using logistic regression adjusted for potential confounders. RESULTS: Incident cognitive impairment was, independently of depression, associated with baseline anxiety disorders in men (odds ratio (OR) = 6.27, 95% confidence interval (CI) = 1.39-28.29) and anxiety symptoms in women (OR = 2.14, 95% = 1.06-4.34). Moreover, the results indicated that depression disorders in men (OR = 8.87, 95% = 2.13-36.96) and anxiety symptoms in women (OR = 4.31, 95% = 1.74-10.67) were particularly linked to incident amnestic cognitive impairment, whereas anxiety disorders in men (OR = 12.01, 95% = 1.73-83.26) were especially associated with incident nonamnestic cognitive impairment. CIND at baseline and incident cognitive impairment were not associated with incident anxiety or depression. CONCLUSION: Anxiety and depression appear to have different relationships with incident cognitive impairment according to sex and the nature of cognitive impairment. Clinicians should pay particular attention to anxiety in older adults because it may shortly be followed by incident cognitive impairment. J Am Geriatr Soc 59:1421-1428, 2011.