Assessment
Tackling Anxiety for Brain Health
Treatment can improve quality of life — and might improve brain health
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For some people, anxiety is an unwelcome companion that shadows daily life. The good news is that chronic, nagging anxiety can be treated and managed later in life, helping protect peace of mind. Emerging research suggests that treating anxiety might help safeguard cognitive health as well.
Previous research revealed a link between late-in-life anxiety and an eventual dementia diagnosis, but it didn’t answer a fundamental question: Is the anxiety an early sign of dementia, or might it contribute to dementia?
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A study published in the Journal of the American Geriatrics Society in 2024 asked that question by focusing on the timing and persistence of anxiety. Analyzing data from more than 2,000 adults in their 60s through 80s, researchers found that people who had chronic anxiety, as well as those with new anxiety, were more likely to be diagnosed with dementia over the next 13 years than people without anxiety. The effect was strongest among participants between the ages of 60 and 70.
Importantly, those whose anxiety had resolved before the five-year follow-up were not at increased risk, leading researchers to conclude that “timely management of anxiety may be a viable strategy in reducing the risk of dementia.”
Note the word “may.” Determining whether anxiety is indeed among the modifiable risk factors for dementia — the things you can do something about, like high blood pressure and hearing loss — will require more research, including double-blind, placebo-controlled clinical trials.
Regardless, getting treatment for an anxiety disorder, whether it’s a new challenge or a longstanding issue, can improve your quality of life.
Anxiety basics
What is anxiety? Is it always a problem? And how does it differ from garden-variety stress?
Anxiety, a fear-based response to a threat or stress, is a normal part of our emotional experience. “It’s a survival mechanism,” says Dr. Robert Hudak, professor of psychiatry at the University of Pittsburgh. Without it, we wouldn’t stop at red lights or head indoors when we hear thunder and lightning.
What leads to anxiety later in life?
Retirement and other transitions or stressful circumstances that become more common later in life, such as the loss of loved ones, health problems and financial worries, can trigger or worsen anxiety.
All of these things can lead to more social isolation, which can exacerbate the anxiety, Laudate says. It’s important to see your primary care doctor to look for medical causes of your symptoms, especially if anxiety seems to appear out of the blue later in life, Hudak says.
Clinical anxiety occurs when worry outstrips the actual threat — either it lingers long after a threat has passed or occurs when our minds conjure “what if…” scenarios. It’s marked by “a pervasive sense of worry [that leaves us] stuck with this ongoing, significant discomfort,” says Corina Laudate, a clinical social worker who works with older adults at McLean Hospital in Belmont, Massachusetts. Clinical anxiety that lasts at least 6 months and interferes with day-to-day functioning may be diagnosed as an anxiety disorder. Some 30 percent of adults experience one of several types of anxiety disorders at some point in life.
Treatment options
Try counseling. The first line of treatment for all types of anxiety is cognitive-behavioral therapy, or CBT, Hudak says. Backed by dozens of studies, CBT involves working with a therapist to examine and gradually shift your thought patterns and your behaviors. A skilled therapist can help with checking your thoughts against reality.
“The behavioral piece is one of the easiest places to intervene,” Laudate says. Something as simple as going for a walk can do amazing things, she notes. In fact, aerobic exercise has been found to help ease symptoms of anxiety as well as depression.
Tackle avoidance. Grappling with avoidance, a key component of anxiety disorders, is an important part of treatment. If a friend invites you to meet her at a park but you feel anxiety about dogs you may encounter, “The worst thing you can do … is not go to the park, even though you want to,” Hudak says. Tackling avoidance doesn’t happen overnight — it’s a process — but in CBT you work to name, recognize and gradually face your fears.
Consider medications. Medications such as SSRIs and SNRIs, also used for depression, can be useful for anxiety disorders, too, especially when combined with therapy.
“It’s rare that someone should be treated with medications alone,” Hudak says. While fast-acting medications like benzodiazepines are sometimes prescribed for acute anxiety, they can be addictive and can affect balance and cognition in older adults.
Talk it out. Practicing self-compassion is invaluable, says Laudate, and social support — in the form of group therapy or connections with friends and family — can counter isolation that can fuel anxiety and provide perspective. “You say out loud what’s been bothering you and let a little sunshine in to disinfect the worry,” she says.
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