Characterizing the phenomenology of anxiety in older adults with subjective cognitive decline

Abstract Background Subjective cognitive decline (SCD), defined as perception of memory or other cognitive decline with normal test performance, is conceptualized as a preclinical stage of Alzheimer’s disease. Formulations of SCD typically include presence of worry or concern regarding the perceived cognitive decline. Accordingly, SCD is associated with anxiety, but its underlying etiology remains unclear. In the current study, we compared mood, anxiety, and personality amongst SCD, mild cognitive impairment (MCI), and cognitively unimpaired (CU) older adults to characterize anxiety in SCD. Methods 146 older adults received psychiatric/medical assessments, self‐report measures of subjective memory, and neuropsychological (NP) tests to establish diagnosis. MCI [n=33,17F, age 72.3(SD6.7)] had subjective memory/other cognitive complaints, impaired NP performance, and functional independence. SCD [n=71,49F, age 71.1(SD6.3)] endorsed subjective memory decline with worry and normal NP performance. CU [n=42, 27F, age 70.6(SD6.8)] had normal NP performance and absence of subjective memory decline with worry. Participants were free of lifetime history of psychiatric illness and neurological conditions. They completed the State Trait Anxiety Inventory (STAI), NEO Five‐Factor Inventory (NEO‐FFI) which includes neuroticism, Health Anxiety Inventory (HAI), and Geriatric Depression Scale (GDS). Multivariate ANOVA was used to examine group differences, followed by post hoc comparisons with Sidak correction. Results Groups differed in STAI‐trait, NEO‐FFI neuroticism, HAI, and GDS [F(2,143)=5.26, P=.006; F(2,143)=3.26, P=.041; F(2,143)=4.61, P=.011; F(2,143)=7.66, P=.046, respectively]. Relative to CU, STAI‐trait and HAI scores were elevated in SCD and MCI (P’s<.05). NEO‐FFI neuroticism was higher in SCD compared to CU (P=.024). No differences between SCD and MCI were detected on any measure. Differences in GDS scores did not survive Sidak correction. Conclusions Anxiety symptoms in SCD without lifetime history of psychiatric illness are best conceptualized as neuroticism, a personality trait that increases proneness to negative affect. Based on non‐elevated levels of state anxiety and depression, anxiety in SCD does not appear to represent an emotional reaction to cognitive decline nor epiphenomena of subclinical depression. Health anxiety, or belief that one has a serious illness, was comparable in SCD and MCI. Future research is needed to clarify the role of neuroticism and its links with subjective and objective memory in SCD.