Objective: The study set out to investigate longitudinally the relationship between those with metamemory complaints presenting with accompanying anxiety. A hypothetical model was proposed interrelating the complaint of memory loss together with anixety and depression, and the final outcome of cognitive impairment, even dementia as defined by DSM-IV.
Design: A cohort followed-up for mean time of 3.2 years and the outcome of scores on the MMSE were recorded, as well as demographic, health, and social characteristics. Various standardized instruments for depression, anxiety, and function were also performed initially and at follow-up.
Materials and Methods: From a general database of 700 patients, a cohort with no dementia and no depression at onset, consisting of 61 persons suffering from anxiety and 76 controls, was studied. A final sample of 100 persons was left for analysis, most having died and some lost to follow-up. Correlation and regression models were run and a path analysis performed.
Results: There was a high relative risk for anxiety sufferers to devlop cognitive impairment (RR=3.96), and the correlation models showed anxiety, complaint of loss of memory to be highly significant. In the regression model, it was shown that the presence of anxiety was a predictor of future cognitive decline. Path analysis showed that the path went from metamemory complaints to anxiety and then either directly to cognitive impairment (p coefficient =2.24) or indirectly via depression (p coefficient =1.53), and then to cognitive decline (p coefficient of 2.03). Depression was not related to metamemory complaints directly.
Conclusion: It would seem from the study that anxiety is the earliest predictor of pre-clinical dementia rather than depression. This is in defference to that reported in the literature stating that depression is a predictor of pre-clinical dementia. Anxiety as an even earlier predictor has not been related to in the literature. Since the need for diagnosing MCI and prediciting those who will develop dementia is becoming important, detecting anxiety in the early onset stage may be another building block in our understanding.
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