Right now, Americans are living longer than ever before. For many people, the transition to older age is approached with acceptance and healthy adjustment. As such, increasing anxiety is not a routine part of aging, and actually tends to be less common in the later years. However, due to stressors such as retirement, declining health, the loss of loved ones, and the loss of independence, some people will struggle with anxiety as they age. Cognitive decline, such as memory loss, is another common cause of anxiety in seniors and may actually intensify future cognitive decline.
When is it More than Just a Senior Moment?
It is typical for people to have some mild memory weakness as they grow older. A temporary lapse in memory is often affectionately referred to as a “Senior Moment.” Common examples include forgetting dates and names or walking into a room and promptly forgetting the reason for entering. However, some individuals experience more frequent and impairing memory loss that goes beyond normal aging; this is referred to as mild cognitive impairment (MCI).
The criteria for MCI include significant memory complaints that are in excess of what is expected in normal cognitive aging for one’s age and education, in the setting of generally preserved cognitive function and ability to maintain ones daily living activities.1,2 Symptoms of MCI are asking questions repeatedly, having trouble with time relationships, and forgetting details of an important event. MCI can be present in up to 30% of people aged 60 years and older.3
The most severe form of cognitive impairment is dementia. The onset of dementia typically follows a progression from normal cognitive aging, to MCI, and then to lastly to dementia. Dementia is diagnosed when someone experiences problems in multiple areas of cognitive functioning such as memory, language, sensory, and executive skills (e.g., planning and organizing skills) that significantly impair their ability to function independently in daily life. Dementia is diagnosed in up to 10% of individuals over the age of 65, and 30% of those over age 80.3,4
How are Anxiety and Cognitive Decline Related?
Studies show that the relationship between anxiety and cognitive decline is bidirectional–anxiety may contribute to and worsen cognitive impairment and people may become anxious when they become aware of memory or other cognitive problems.5 It is important to remember that the precise nature of the interaction may be different for different people. However, for some people, anxiety may worsen problems with cognition over time. For example, someone with MCI and anxiety symptoms has two times the risk of developing dementia than someone with MCI alone.6 Because of this, identifying which anxiety symptoms are most strongly associated with cognitive deficits is important to be able to ensure that people who are at risk for developing dementia can get the best care as early as possible. Two of the anxiety symptoms that are most closely related to cognitive deficits and decline are 1) worry and 2) problems with decision making.6,7,8
How to Self-Treat Worry and Problems with Decision-Making
There are many steps that people can take to better manage anxiety and decision-making problems on their own:
- Overall Health: Start with taking care of your overall health and well-being. Proper nutrition, exercise, and sleep habits are essential.
- Stay Active: Keeping active and socially engaged can bring joy to your life and provide you with helpful support from friends and family.
- Relax: Working in some relaxing activities to your daily schedule may also help. It is good to choose activities that are well–suited to your interests. For some people, listening to music is relaxing while others may enjoy yoga or meditation.
Professional Support for Treating Anxiety is Also Available
If you experience anxiety that is bothersome or interfering with your daily routine or social interactions, than it is important to seek help from a professional. You may want to start by speaking with your primary care or family doctor about your symptoms. Other professionals who may be able to help are psychologists, psychiatrists, and licensed social workers or professional counselors. There are several types of professional treatments available. Here are two of the most common:
- Medications: There are two general types of medications that are commonly used to treat problems with anxiety.
- Antidepressants: Antidepressants are commonly used to treat anxiety by increasing the amount of neurotransmitters in the brain. The antidepressants most often used to treat anxiety work by increasing the amounts of serotonin in the brain. Some also work by increasing neurepinephrine.
- Anxiolytics: Medications called “anxiolytics” can also help with anxiety by enhancing the calming effects of GABA in the brain. Still, it is important to talk with a professional about which suits you best. For example, some anxiolytics are “short acting” meaning they can make you feel less anxious very quickly, but the effect may be short-lived. This type of medication may also be habit-forming, so it is important not to rely on them for long-term treatment.
- Therapy: Many seniors have success using counseling, specifically a form of counseling called cognitive-behavioral therapy (CBT), to reduce anxiety. During CBT, a therapist will help you to set goals and share anxiety management skills to help you reach those goals. Some examples of strategies taught during CBT are relaxation skills training, skills for changing negative self-talk, problem-solving skills, and learning ways to take action in your life (for example to make a decision), even when you may be you don’t have all the information to be certain about the outcome.
What Should I do if I’m Concerned About my Memory?
As people grow older, some changes in memory are normal. However, if you believe memory loss is becoming an issue for you or a loved one, asking for an evaluation is essential so that the person in question can review and choose from the available treatment options. If you are concerned with memory loss, the first plan of action is to visit your doctor for a professional assessment of memory impairment and a diagnosis of the cause. Your doctor will conduct a cognitive examination, review your medications, ask you questions related to history of head injury and mental health concerns, and review or order some laboratory tests with the aim of detecting conditions that may be treatable causes of memory loss. It’s a good idea to bring along a family member or a friend who can provide some insight based on their observations.
While it may be difficult to admit to memory loss, obtaining an early diagnosis will lead to the best possible treatment and can allow for needed planning in handling cognitive impairment or early stages of dementia. Some methods of intervention that have been helpful in treating dementia and reducing the rate of memory loss in MCI include: 3,9
- Physical and mental exercise
- Nutritional improvements
- Cognitive Behavioral Therapy
- Emotion-focused psychotherapies
- Problem-solving therapy
Help is Available
The senior years can be a difficult time for people with anxiety and/or cognitive decline. However, it is important to remember that help is available. Choosing the best treatment option will be based upon an evaluation with a professional to better understanding how anxiety and cognition are uniquely related for each individual. Given that anxiety can increase risk for progression to dementia for those with MCI, identification and early intervention in this at-risk group is particularly important.
1. Petersen, R.C., Doody, R., Kurz, A., Mohs, R.C., Morris, J.C, Rabins, P.V., …Winblad, B. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58(12), 1985-1992.
2. Sosa-Ortiz, A.L., Acosta-Castillo, I., & Prince, M.J. (2012). Epidemiology of dementias and Alzheimer’s disease. Archives of Medical Research, 43, 600-608.
3. Beaudreau, S.A., & O’Hara, R. (2008). Late-life anxiety and cognitive impairment: a review. The American Journal of Geriatric Psychiatry, 16(10), 790-803.
4. Hendrie, H.C. (1998). Epidemiology of dementia and Alzheimer’s disease. The American Journal of Geriatric Psychiatry,6(2), S3-S18.
5. Wolitzky-Taylor, K.B., Castriotta, N., Lenze, E.J., Stanley, M.A., & Craske MG. (2010). Anxiety disorders in older adults: a comprehensive review. Depression and Anxiety,27, 190-211.
6. Palmer, K., Berger, A.K., Monastero, R., Winblad, B., Backman, L., & Fratiglioni, L. (2007). Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology, 68, 1596-1602.
7. Diefenbach, G. J., Bragdon, L.B., & Blank, K. (2014). Geriatric Anxiety Inventory: Factor Structure and Associations with Cognitive Status. American Journal of Geriatric Psychiatry 22, 1418-1426.
8. Pietrzak, R.H., Maruff, P., Woodward, M., Fredrickson, J., Fredrickson, A., Krystal, J.H.,…Darby, D. (2012) Mild worry symptoms predict decline in learning and memory in healthy older adults: a 2-year prospective cohort study. The American Journal of Geriatric Psychiatry, 20(3), 266-275.
9. Small, G., & Vorgan, G. (2012). The Alzheimer’s Prevention Program: Keep your brain healthy for the rest of your life. New York, NY: Workman Publishing.