Neuropsychological Correlates of Anxiety in Older Adults: A Cross-Sectional Comparison with Controls Without a Psychiatric Diagnosis.

BACKGROUND/OBJECTIVES: Anxiety symptoms are common in older adults and are associated with cognitive changes; however, the specific pattern of deficits and the effects of anxiety diagnosis, symptom severity, and depressive symptoms remain unclear. This study compared cognitive performance between older adults with anxiety-related diagnoses and psychiatrically healthy controls and examined factors associated with cognitive outcomes. METHODS: This cross-sectional study included 130 participants aged ≥ 65 years: 70 with an anxiety-related diagnosis (SCID-5-CV) and 60 controls without psychiatric diagnoses. Cognition was assessed using the SMMSE, Enhanced Cue Recall Test, Clock Drawing Test, Verbal Fluency Test, and Trail Making Test Parts A and B; anxiety and depressive symptoms were assessed with validated scales. RESULTS: The anxiety group had higher anxiety and depression scores than controls (FDR-adjusted q < 0.001). They showed longer Trail Making Test A, B, and B-A times and lower free recall and enhanced cue recall scores (q = 0.019 and q < 0.001, respectively). No differences were observed in global cognition, clock drawing, or verbal fluency after correction. Most symptom-cognition correlations did not survive Bonferroni correction, except for state anxiety and enhanced cue recall. In regression analyses, anxiety-related diagnosis showed a more consistent association with cognition than anxiety symptom severity, along with education, age, gender, and depressive symptoms. CONCLUSIONS: Older adults with anxiety-related diagnoses showed selective impairments in processing speed, attention, executive functions, and memory despite preserved global cognitive screening. Cognitive outcomes in late-life anxiety appear more closely related to diagnostic status and other clinical/demographic factors than to anxiety severity alone.