73. THE IMPACT OF SELF- AND CAREGIVER-PERCEIVED ANXIETY SEVERITY ON COGNITIVE FUNCTIONING

Abstract

Introduction

Existing literature indicates that anxiety negatively affects memory, attention, and executive functions. High anxiety levels are linked to notable cognitive deficits, which can exacerbate daily challenges associated with cognitive impairment (Gaillard et al., 2021; Vytal et al., 2020; Hwang et al., 2023; Wang et al., 2022). Some studies report an inverse correlation between higher levels of self-reported anxiety and lower performance on cognitive test scores, while others do not find such links. However, discrepancies often exist between self-reported anxiety and caregiver reports of a patient's anxiety, with caregivers sometimes rating anxiety higher (Gulpers et al., 2022; Kaser et al., 2023; Brunet et al., 2019). These differences underscore the importance of using both self-reports and caregiver reports in neuropsychological evaluations, as they offer complementary insights into an individual's subjective experience and observable symptoms (Goodarzi et al., 2019). The study aims to explore whether higher anxiety levels, as perceived by both patients and caregivers, correlate with poorer performance on measures of attention, processing speed, and executive functioning in older adults.

Methods

This study cohort consisted of individuals who presented to a community outpatient neuropsychology clinic with cognitive concerns and underwent comprehensive neuropsychological assessment. Participants who completed the Geriatric Anxiety Scale (GAS), had a caregiver complete the Neuropsychiatric Inventory Questionnaire (NPI-Q), and completed various neuropsychological tests of attention, executive functioning, and processing speed (Delis-Kaplan Executive Functioning System – Trails Making Test, Verbal Fluency, Color Word Interference Test, Wechsler Adult Intelligence Scale – Digit Span, Coding) were included in the final sample. Descriptive statistics, correlations, and regression analyses were completed to investigate the relationship between self-reported anxiety symptoms, caregiver assessment of anxiety symptoms, and measures of cognitive functioning.

Results

A total of 578 participants were included in the study. The overall sample had a mean age of 76.45 years (SD = 7.09) and an average of 15.29 years of education (SD = 2.58). The average levels of anxiety symptoms reported reflected minimal levels for both patient self-report (M = 11.52, SD = 9.03) and caregiver report (M = 0.74, SD = 1.24). A correlation analysis revealed a statistically significant relationship between the caregiver's report of anxiety symptoms and the patient's self-report of anxiety symptoms (r = .23, p LESS THAN .01) and the caregiver's report of anxiety symptoms in relation to performance on measures of auditory attention (r = -.08, p = .05) and processing speed (r = -.12, p = .03). An initial hierarchical regression analysis investigating the relationship of demographic variables, patient report of anxiety and caregiver report of severity of anxiety on auditory attention found statistically significant associations of caregiver perception of anxiety (t = -2.23, p = 0.03) and education (t = 4.31, p = .00) with auditory attention. A secondary hierarchical analysis focusing on the above demographic variables and performance on a measure of processing speed found no statistically significant relationship among the variables.

Conclusions

This study explored the relationship between patient- and caregiver reports of anxiety symptoms and aspects of cognitive functioning, revealing significant associations with auditory attention. Specifically, older adults displayed poorer performance on a measure of auditory attention with higher severity of anxiety symptoms reported by a caregiver, underscoring the need to consider multiple information sources when assessing anxiety's impact on cognition in older adults. The findings emphasize the impact of anxiety on cognitive functions such as attention, as well as the importance of considering multiple perspectives when assessing anxiety amongst older adults, as relying solely on the self-report may not provide the complete picture of anxiety symptoms. Lastly, providing psychoeducation to patients and caregivers about the relationship between anxiety and cognitive performance may help improve understanding and engagement in treatment.