By what percentage can anxiety disorder increase the risk of dementia?

Anxiety Disorder Increases Dementia Risk by Approximately 24-29%

According to the most recent high-quality research, anxiety disorder increases the risk of all-cause dementia by approximately 24-29%, with chronic and new-onset anxiety showing even higher risk at up to 280-320% increased risk in certain populations. 1, 2

Evidence on Anxiety-Dementia Connection

Risk Magnitude

• The most recent meta-analysis of prospective cohort studies (2020) found that anxiety is associated with a 24% increased risk of all-cause dementia (RR 1.24,95% CI: 1.06-1.46) 1
• A previous meta-analysis (2019) reported similar findings with a 29% increased risk (RR 1.29,95% CI: 1.01-1.66) 3
• The most recent longitudinal study (2024) found that:
  • Chronic anxiety increased dementia risk by 280% (HR 2.80,95% CI 1.35-5.72)
  • New-onset anxiety increased risk by 320% (HR 3.20,95% CI 1.40-7.45)
  • Notably, resolved anxiety did not significantly increase dementia risk 2

Age-Related Considerations

• The anxiety-dementia association appears stronger in younger elderly populations (under 70 years), with risk increases of:
  • 458% for chronic anxiety (HR 4.58,95% CI 1.12-18.81)
  • 721% for new-onset anxiety (HR 7.21,95% CI 1.86-28.02) 2

Relationship with Depression

• The anxiety-dementia relationship may be partially shaped by depressive symptoms
• When controlling for depression, the association between anxiety and dementia is attenuated in some studies 4
• This suggests potential overlapping mechanisms or that anxiety and depression may work synergistically to increase dementia risk

Clinical Implications

Risk Identification

• Primary care providers should be vigilant for anxiety disorders in older adults, as they represent a potentially modifiable risk factor for dementia 5
• First-episode psychiatric symptoms in later life, including anxiety, should be assessed with a high index of suspicion for neurocognitive disorders 5

Assessment Approach

• Using validated informant-rated scales like the Neuropsychiatric Inventory (NPI-Q) or Mild Behavioural Impairment Checklist (MBI-C) can help operationalize assessment of neuropsychiatric symptoms including anxiety 5
• Consider referral to memory clinics for older adults with late-life emergent and sustained neuropsychiatric symptoms, including anxiety 5

Intervention Potential

• The population attributable fraction (PAF) of dementia due to anxiety is estimated at 3.9%, suggesting that effective anxiety treatment could potentially reduce dementia incidence 1
• Timely management of anxiety may be a viable strategy for reducing dementia risk, as resolved anxiety appears to return risk to baseline levels 2

Caveats and Considerations

• Anxiety prevalence in dementia patients ranges widely from 8% to 71%, making precise risk assessment challenging 6
• Anxiety symptoms gradually decrease at severe stages of dementia, suggesting a complex relationship throughout disease progression 6
• It remains unclear whether anxiety is a true causal risk factor for dementia or represents an early prodromal symptom of the neurodegenerative process 1, 3
• The average time to dementia diagnosis after anxiety assessment was approximately 10 years in longitudinal studies, suggesting a long-term relationship 2

In clinical practice, identifying and treating anxiety disorders should be considered not only for immediate symptom relief but potentially as part of a comprehensive dementia risk reduction strategy, particularly in adults under 70 years of age.