is anxiety a risk factor for dementia?
DESCRIPTION
Is anxiety a risk factor for dementia?. John Gallacher Tony Bayer Mark Fish Yoav Ben-Shlomo Frank Dunstan. Active ageing research group: www.activeageing.co.uk. CaPS: Methods. Total cohort 2,959 men aged 45-59 at recruitment Measures at C2 (2 nd examination: C1 + 5 years) - PowerPoint PPT PresentationTRANSCRIPT
Is anxiety a risk factor for dementia?
John GallacherTony BayerMark Fish
Yoav Ben-ShlomoFrank Dunstan
Active ageing research group: www.activeageing.co.uk
CaPS: Methods
Total cohort– 2,959 men aged 45-59 at recruitment
Measures at C2 (2nd examination: C1 + 5 years)
– Trait anxiety (STAI)– Vascular risk factors– CHD– Demographics
Measures at C3 (C2 + 5 years)
– NART (pre-morbid cognitive function)
Measures at C5 (C2 + 17 years: men aged 67-81 years)
– Cognitive impairment: CIND, Dementia
Statistical analysis
• Logistic regression• Outcomes:
– Overall impairment (CIND + Dementia)– CIND– Dementia
• Adjustment for covariates:– age, sbp, cholesterol, alcohol consumption– social class, marital status, smoking, diabetes, leisure activity
• Adjustment for pre-morbid cognitive function– NART at C3
Available data: Sample size main analysismen with complete covariate data
Cog. healthy Vascular Non vascular
Total
Cog. healthy 783 0 0 783
CIND 0 29 99 128
Dementia 0 33 38 71
Total 783 62 137 982
Available data: Sample size 20 analysismen with complete covariate data
and no evidence of decline at baseline
Cog. healthy Vascular Non vascular
Total
Cog. healthy 655 0 0 655
CIND 0 16 65 81
Dementia 0 7 12 19
Total 655 23 77 755
Distribution of Trait Anxiety
Point of change(Anxiety score=31)
0.1
0.2
0.3
Fre
quen
cy (
prop
ortio
n) o
f anx
iety
sco
re
0.2
.41
Like
lihoo
d of
cog
nitiv
e im
pair
men
t
20 30 40 50 60 70Anxiety score
impairmentanxiety scoredistribution
Anxiety and cognitive impairment 31st-95th centile in 982 men with complete data
Severity of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
All impairment 2.87
(1.68, 4.88)
p<0.001
2.60
(1.50, 4.51)
p=0.001
2.19
(1.24, 3.88)
p=0.007
CIND
only
2.85
(1.55, 5.26)
p=0.001
2.62
(1.39, 4.94)
p=0.003
2.31
(1.20, 4.44)
p=0.012
Dementia only
2.89
(1.28, 6.54)
p=0.11
2.73
(1.16, 6.45)
p=0.022
2.37
(0.98, 5.71)
p=0.056
Anxiety and all cognitive impairment 31st-95th centile in 755 men with complete data
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 3.81
(2.17, 6.70)
p<0.001
3.38
(1.89, 6.05)
p<0.001
2.45
(1.28, 4.68)
p=0.007
Vascular 2.21
(1.01, 4.84)
p=0.047
1.95
(0.85, 4.49)
p=0.117
1.94
(0.77, 4.89)
p=0.160
Anxiety and CIND 31st-95th centile in 755 men with complete data
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 4.00
(2.16, 7.42)
p<0.001
3.56
(1.88, 6.74)
p<0.001
2.70
(1.33, 5.51)
p=0.006
Vascular 2.00
(0.67, 5.97)
p=0.214
1.80
(0.57, 5.70)
p=0.321
1.18
(0.31, 4.56)
p=0.807
Anxiety and Dementia 31st-95th centile in 755 men with complete data
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 3.12
(1.12, 8.70)
p<0.030
2.83
(0.97, 8.221)
P=0.056
1.97
(0.60, 6.50)
p=0.267
Vascular 2.69
(0.96, 7.59)
p=0.061
2.28
(0.75, 6.96)
p=0.147
3.38
(1.02, 11.2)
p=0.046
Anxiety and cognitive impairment 31st-95th centile in 755 men with complete data
and no evidence of decline at baseline
Severity of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
All impairment 4.02
(2.05, 7.91)
p<0.001
3.76
(1.84, 7.69)
p<0.001
3.36
(1.61, 7.01)
p=0.001
CIND
only
3.75
(1.82, 7.76)
p<0.001
3.60
(1.67, 7.79)
p=0.001
3.32
(1.51, 7.31)
p=0.003
Dementia only
5.03
(1.24, 20.5)
p=0.024
4.24
(0.92, 20.0)
p=0.065
3.60
(0.74, 17.4)
p=0.112
Conclusion
Anxiety is associated with cognitive impairment– Duration of follow-up (17 yrs) suggests causal
association– Insidious nature of cognitive decline means reverse
causality cannot be ruled out – No control for depression: association may not be
independent– Analyses for dementia likely to be conservative due to
survivor effect– Some evidence that effect is stronger for non-vascular
dementia
Further work: “Age well, feel good”
Pilot Study: – October 2008-March 2009– 3,000 older persons: 60+ years
• 15,000 mailed invitations• Web links from interest groups
– Remote• Recruitment (web)• Consent (web)• Assessment (web)• Bio-sampling (mail)• Follow-up (record linkage)
Anxiety and all cognitive impairment 31st-95th centile in 755 men with complete data
and no evidence of decline at baseline
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 4.32
(2.08, 8.95)
p<0.001
4.13
(1.91, 8.96)
p<0.001
3.65
(1.61, 8.28)
p=0.002
Vascular 3.17
(0.90, 11.2)
p=0.073
2.81
(0.71, 11.1)
p=0.141
2.76
(0.68, 11.1)
p=0.155
Anxiety and CIND 31st-95th centile in 755 men with complete data
and no evidence of decline at baseline
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 4.78
(2.24, 10.2)
p<0.001
4.73
(2.10, 10.7)
p<0.001
4.23
(1.78, 10.0)
p=0.001
Vascular 1.24
(0.23, 6.72)
p=0.806
1.05
(0.17, 6.47)
p=0.957
1.08
(0.17, 6.73)
p=0.935
Anxiety and dementia 31st-95th centile in 755 men with complete data
and no evidence of decline at baseline
Type of impairment
Adjusted for age Adjusted for age + vascular risk
Adjusted for age
+vascular risk
+pre-morbid CF
Non Vascular 1.83
(0.25, 13.4)
P=0.549
1.42
(0.17, 12.0)
P=0.750
1.23
(0.14, 11.1)
p=0.851
Vascular 15.6
(2.00, 121)
p=0.009
20.8
(1.71, 253)
p=0.017
19.2
(1.41, 751)
p=0.063