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Anxiety symptoms, anxiolytic medications and cognitive impairment in older adults

Kassem, Ahmed (2015) Anxiety symptoms, anxiolytic medications and cognitive impairment in older adults. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Worldwide, anxiety disorders are the sixth leading cause of all years of life lived with disability, ahead of diabetes, cancers and stroke. In the United States, anxiety disorders are the most common mental disorders among older adults. It is well documented that anxiety and cognitive impairment co-occur in older adults, however, the nature of this relationship remains unclear. Further, medications that are used to manage anxiety symptoms and disorders appear to be increasing in the general population with paucity of information about trends in older adults. Using three population-based studies, this dissertation investigated anxiety symptoms in older men and women with a focus on anxiety-related medications and impact of anxiety on future cognitive functioning. We found that the use of anxiolytic and antidepressant medications increased in an aging cohort over ten years with higher prevalence in women than men. We also found that some predictors of anxiolytic and antidepressant medications use were common among both men and women, while some predictors were potentially gender-specific. In a cohort of oldest old women, we found that mild anxiety symptoms were associated with increased odds of incident dementia over five years. We also found that change in anxiety symptoms over time was associated with increased risk of dementia. We did not observe an association between anxiety symptoms and mild cognitive impairment. In a cohort of older men, we found that anxiety symptoms were associated with greater declines in both global cognitive function and executive function over three years. We also found that such a decline reached clinically significant level in executive function but not in global cognitive function. Taken together, these findings are of major public health relevance as they highlight the significance of anxiety symptoms in older adults. Findings from this research will improve our understanding of the role of anxiety as a predictor of future cognitive impairment. It is critical to clarify whether anxiety can early identify those at higher risk or it is a potentially modifiable risk factor. Findings from this research will also inform future intervention research that targets older users of anxiety-related medications.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Kassem, Ahmedamk192@pitt.eduAMK192
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairCauley, Janejcauley@edc.pitt.eduJCAULEY
Committee MemberGanguli, MaryganguliM@upmc.eduGANGULIM
Committee MemberHanlon, Josephjth14@pitt.eduJTH14
Committee MemberLopez, Oscarlopezol@upmc.eduOLLOPEZ
Committee MemberWilson, Johnjww@pitt.eduJWW
Committee MemberYaffe,
Date: 29 June 2015
Date Type: Publication
Defense Date: 19 March 2015
Approval Date: 29 June 2015
Submission Date: 6 April 2015
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 135
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: anxiety, anxiolytic medications, cognition, dementia, mild cognitive impairment, gender, older adults
Date Deposited: 29 Jun 2015 15:26
Last Modified: 01 May 2017 05:15


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