Relationship between anxiety and cognitive performance in an elderly population with a cognitive complaint.

BACKGROUND AND PURPOSE: Almost half of elderly patients being consulted in memory clinics present anxiety disorders, either with or without an associated depressive syndrome. This study investigates the relationship between the level of anxiety and cognitive performance in a population complaining of memory difficulties. METHODS: The study population (n = 149) was selected from the EVATEM cohort, which included subjects aged 65 years or older. All subjects presented memory complaints and patients with depression were excluded. Anxiety level was assessed with the Hamilton Anxiety Rating Scale. A standard neuropsychological battery, including a free and cued episodic memory test, was administered to examine the different processes of verbal episodic memory, visual memory, executive, visuoconstructive and instrumental functions. RESULTS: Subjects with moderate to severe anxiety had worse performance than subjects with no anxiety in retrieval and storage processes of verbal episodic memory (respectively P = 0.004 and P = 0.02) and in visual recognition memory (P = 0.01). No relationship was found between anxiety and executive, visual-constructive or instrumental functions. CONCLUSION: Anxiety impacts several stages of verbal memory, notably the processes of storage and retrieval, and visual recognition memory within a population having cognitive complaints. This study suggests that anxiety should be considered as a factor of memory vulnerability for patients being treated in memory clinics.

Performance of cognitive tests, individually and combined, for the detection of cognitive disorders amongst community-dwelling elderly people with memory complaints: the EVATEM study.

BACKGROUND AND PURPOSE: Dementia is a leading cause of dependence amongst the aged population. Early identification of cognitive impairment could help to delay advanced stages of dependence. This study aimed at assessing the performance of three neuropsychological tests to detect cognitive disorders in elderly subjects with memory complaints. METHODS: The EVATEM study is a prospective multicentre cohort with a 1-year follow-up. Subjects with memory complaints were selected during preventive health examinations, and three neuropsychological tests (five-word, cognitive disorders examination, verbal fluency) were administered. Two groups were identified in memory clinics: (i) cognitively healthy individuals (CHI) and (ii) mild cognitive impairment or demented individuals (MCI-DI). Cross-sectional analyses were performed on data at inclusion. The relationship between the diagnosis of MCI-DI/CHI and the neuropsychological tests was assessed using logistic regressions. The performance of the neuropsychological tests, individually and combined, to detect cognitive disorders was calculated. RESULTS: Of 585 subjects, 31.11% had cognitive disorders (MCI, 176 subjects; DI, six subjects). Amongst the three tests studied, the odds ratio for MCI-DI was higher for the five-word test <10 [odds ratio 3.2 (1.81; 5.63)]. The best performance was observed when the three tests were combined: specificity 90.5% and sensitivity 42.4% compared to respectively 89.2% and 28.3% for the five-word test. CONCLUSIONS: Despite the poor sensitivity of the five-word test, it seems to be the most adapted for the diagnosis of MCI-DI in older adults with a memory complaint, in prevention centres, taking into account its high specificity and its rapid administration compared to the other tests.