Is anxiety a risk factor for dementia? John Gallacher Tony Bayer Mark Fish Yoav Ben-Shlomo Frank Dunstan Active ageing research group:

CaPS: Methods Total cohort –2,959 men aged at recruitment Measures at C2 (2 nd 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 (C years: men aged 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 analysis men with complete covariate data Cog. healthyVascularNon vascular Total Cog. healthy78300 CIND Dementia Total

Available data: Sample size 2 0 analysis men with complete covariate data and no evidence of decline at baseline Cog. healthyVascularNon vascular Total Cog. healthy65500 CIND Dementia Total

Distribution of Trait Anxiety

Anxiety and cognitive impairment 31 st -95 th centile in 982 men with complete data Severity of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF All impairment 2.87 (1.68, 4.88) p< (1.50, 4.51) p= (1.24, 3.88) p=0.007 CIND only 2.85 (1.55, 5.26) p= (1.39, 4.94) p= (1.20, 4.44) p=0.012 Dementia only 2.89 (1.28, 6.54) p= (1.16, 6.45) p= (0.98, 5.71) p=0.056

Anxiety and all cognitive impairment 31 st -95 th centile in 755 men with complete data Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 3.81 (2.17, 6.70) p< (1.89, 6.05) p< (1.28, 4.68) p=0.007 Vascular 2.21 (1.01, 4.84) p= (0.85, 4.49) p= (0.77, 4.89) p=0.160

Anxiety and CIND 31 st -95 th centile in 755 men with complete data Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 4.00 (2.16, 7.42) p< (1.88, 6.74) p< (1.33, 5.51) p=0.006 Vascular 2.00 (0.67, 5.97) p= (0.57, 5.70) p= (0.31, 4.56) p=0.807

Anxiety and Dementia 31 st -95 th centile in 755 men with complete data Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 3.12 (1.12, 8.70) p< (0.97, 8.221) P= (0.60, 6.50) p=0.267 Vascular 2.69 (0.96, 7.59) p= (0.75, 6.96) p= (1.02, 11.2) p=0.046

Anxiety and cognitive impairment 31 st -95 th centile in 755 men with complete data and no evidence of decline at baseline Severity of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF All impairment 4.02 (2.05, 7.91) p< (1.84, 7.69) p< (1.61, 7.01) p=0.001 CIND only 3.75 (1.82, 7.76) p< (1.67, 7.79) p= (1.51, 7.31) p=0.003 Dementia only 5.03 (1.24, 20.5) p= (0.92, 20.0) p= (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 31 st -95 th centile in 755 men with complete data and no evidence of decline at baseline Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 4.32 (2.08, 8.95) p< (1.91, 8.96) p< (1.61, 8.28) p=0.002 Vascular 3.17 (0.90, 11.2) p= (0.71, 11.1) p= (0.68, 11.1) p=0.155

Anxiety and CIND 31 st -95 th centile in 755 men with complete data and no evidence of decline at baseline Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 4.78 (2.24, 10.2) p< (2.10, 10.7) p< (1.78, 10.0) p=0.001 Vascular 1.24 (0.23, 6.72) p= (0.17, 6.47) p= (0.17, 6.73) p=0.935

Anxiety and dementia 31 st -95 th centile in 755 men with complete data and no evidence of decline at baseline Type of impairment Adjusted for ageAdjusted for age + vascular risk Adjusted for age +vascular risk +pre-morbid CF Non Vascular 1.83 (0.25, 13.4) P= (0.17, 12.0) P= (0.14, 11.1) p=0.851 Vascular 15.6 (2.00, 121) p= (1.71, 253) p= (1.41, 751) p=0.063