Is Anxiety a Hidden Risk Factor for Dementia? Experts Weigh In

Anxiety is a common condition that can cause a host of physical and psychological symptoms. Now, a growing body of research suggests it may be associated with an increased risk of cognitive issues, too.

A study published in July in the Journal of the American Geriatrics Society found that older people with anxiety—particularly those aged 70 or younger—had a greater risk of developing dementia as they aged compared to those without anxiety.

This was true for both people with chronic or longer-lasting anxiety and for people with new-onset anxiety, the researchers found.

However, the study’s results showed a silver lining, too—once participants’ anxiety was resolved, that elevated dementia risk appeared to decrease.

“The findings suggest that anxiety may be a new risk factor to target in the prevention of dementia, and also indicate that treating anxiety may reduce this risk,” study author Kay Khaing, MMed, conjoint lecturer at the University of Newcastle’s School of Medicine and Public Health, said in a press release.

Here’s what experts had to say about the link between anxiety and dementia and what the study’s findings could mean for how dementia is prevented and treated going forward.

Previous research has consistently pointed to a connection between anxiety and an increased risk of developing dementia, Michele Nealon, PsyD, licensed clinical psychologist and president of The Chicago School, told Health.

This is especially true for chronic anxiety, added Ozan Toy, MD, MPH, neuropsychiatrist and chief medical officer at Telepsychiatry.

But even though there’s plenty of research on the connection more broadly, “prior research has not always differentiated between chronic and new-onset anxiety,” Toy told Health.

That’s where this Journal of the American Geriatrics Society study adds to the conversation.

Khaing and the other researchers looked at data from 2,132 participants living in Australia. They had an average age of 76, though the youngest participants were in their 50s.

Researchers checked in with the participants at the start of the study and then again five years later to ask about their mental health. There were 221 participants with chronic anxiety who had anxiety symptoms at both check-ins. An additional 117 people had developed new-onset anxiety at the second check-in.

After documenting how many study participants developed dementia, the researchers found people with either type of anxiety had an increased risk of developing cognitive issues. Specifically, those with new-onset anxiety were 3.2 times more likely to develop dementia as compared to those without anxiety. For people with chronic anxiety, the risk was 2.8 times greater.

However, participants who had anxiety during the first but not the second check-in—meaning their anxiety symptoms were effectively treated—did not have an elevated dementia risk.

A number of studies—including this newer one—have shown that living with anxiety earlier in life may be linked to cognitive impairment down the line. But importantly, “this was not a causative relationship,” said Stacey Podkovik, DO, a neurosurgery resident at Riverside University Health System.

Though it’s not totally clear why this association exists, there are a number of potential mechanisms.

One prevailing idea, Podkovik told Health, is that anxiety tends to increase the risk of cardiovascular disease—especially in younger patients. “There have been many studies that have demonstrated cardiovascular disease as a risk factor for dementia,” he said. “By reducing anxiety in younger individuals, it likely helps decrease the chronic strain on one’s overall cardiovascular health.”

Another theory is that stress hormones such as cortisol could have a negative impact on the brain, particularly when they interact with regions involved in memory and cognitive function, said Nealon.

Similarly, chronic anxiety could contribute to a prolonged stress response in the body, which in turn could lead to neuroinflammation and neuronal damage—both of these are risk factors for dementia, Toy explained.

On top of that, anxiety often co-occurs with other conditions, such as depression and sleep disorders, which are also linked to dementia, Nealon pointed out. This makes it harder to study anxiety independent of other risk factors but also suggests that anxiety might contribute to dementia through multiple overlapping pathways, she said.

The fact that the study found people did not have a greater dementia risk once their anxiety was effectively treated could give some of these theories more credence.

“The resolution of anxiety could potentially halt or reverse these processes, reducing the associated [dementia] risk,” Toy said.

But on the other hand, “another possible explanation could be that anxiety is actually more of an epiphenomenon, or a marker for the dementia process which is developing,” he said.

This could explain why, in the study, new-onset anxiety was closely related to dementia. Losing one’s memory could be causing anxiety, not the other way around.

“In the beginning, when they realize their memory is deteriorating, it makes sense that a person would become very anxious about developing memory problems,” Toy explained.

Despite the existing evidence, experts agreed more studies are needed to further explain this link. However, if anxiety is confirmed as a significant risk factor for dementia, it could have profound implications for public health, Nealon said.

“It would necessitate the inclusion of mental health care as a key component of dementia prevention strategies,” she explained. “Screening for anxiety in midlife could become a routine part of health assessments, and early intervention could be emphasized in public health campaigns.”

Anxiety can affect people at any age, but the risk of its association with dementia has been studied more so in older adults, particularly those over age 60, Toy explained. Still, it’s best to screen for or address anxiety as early as possible—around 40 years old would be ideal for cognitive health specifically, Nealon said.

“[The brain’s] ability to adapt and reorganize decreases with age, making the brain more vulnerable to the effects of chronic stress and anxiety,” she said. “For younger adults, untreated anxiety can set a foundation for later cognitive issues.”

But again, treating anxiety seems to reduce the associated risk of dementia, which suggests that the brain still has a degree of resilience, even as we age, said Nealon.

“If the damaging effects of chronic anxiety are halted early enough, the brain may recover, and the progression toward dementia might be slowed or prevented,” she explained. “This underscores the importance of timely and effective treatment for anxiety.”

Anxiety treatment typically includes a combination of psychotherapy (such as cognitive behavioral therapy) and pharmacotherapy with antidepressant medications, Toy explained. Lifestyle or behavioral changes, such as more exercise, mindfulness, and social engagement, are also key, he added.

“If someone has excessive or persistent anxiety, we advise [them] to seek help, as anxiety can be recovered and treated,” Khaing told Health. “That also helps reduce the risk of dementia in later life.”