Late-life anxiety and mild cognitive impairment

Cognitive decline has become a major burden to society, so if one could delay the decline by initiating treatment as early as possible, the savings for both the individual and society would be significant. The importance of relating to Mild Cognitive Impairment concerns the high annual conversion rates of up to 30% for this disorder. Thus, the importance of finding the predictors for further cognitive decline is of the highest priority. Researchers have proposed the use of neuroimaging, biomarkers, use of EEG brain wave patterns, neuropsychological testing or a combination of them. Amongst the neuropsychological clinical entities examined have been the mood disorders depression and anxiety. Depression has been reported to be a predictor for future cognitive decline, but with regard to anxiety, the question is debatable. In some studies of elderly with memory problems, the presence of anxiety was highly predictive of future cognitive decline. However in studies with MCI cohorts, though anxiety is found in up to 40% of MCI sufferers, it was found not to be a predictor. A possible theoretical explanation is that elderly turning for an assessment are at Braak's stage I/II and in those diagnosed with MCI, are at Braak's stage III/IV. At the earlier stages (stage I/II), flow of information via the entorhinal cortex to the hippocampus is impaired resulting in hyperactivity of the alternate pathway of the amygdala, which explains the high prevalence of anxiety. However, by the time a person turns to a specialized cognitive clinic and is diagnosed with amnestic-MCI (stage III /IV) flow via the alternative pathway of the amygdala though present, is now partially impaired. After conversion to dementia (stage V), only a few were still with anxiety since now the pathway to the amygdala was also impaired. In conclusion, anxiety is prominent in persons with amnestic MCI, but this did not predict future cognitive decline, perhaps since persons with MCI turning for cognitive assessment, probably have early onset of dementia. There does however seem to be a trend that those with anxiety and MCI do tend to develop cognitive decline at slight higher rates.