Abstract
BackgroundDeficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders.Methods189 Swedish patients aged 18–65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test.ResultsMore severe anxiety was associated with lower digit span test scores (R2 = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests.ConclusionsSeverity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.
Highlights
Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent
Full statistical information including means and standard deviation (SD) are shown in Additional file 4. In this cohort of primary care patients with anxiety disorders (PD, generalized anxiety disorder (GAD) and anxiety not otherwise specified), higher anxiety score was associated with lower executive function (EF) related to working memory (WM) in multivariable models, after adjustment for comorbid major depression
In primary care patients with anxiety (PD, GAD and anxiety not otherwise specified) anxiety severity is negatively associated with EFs related to WM after adjustment of major depression
Summary
Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. EF refers to several “top-down”, effortful cognitive processes needed to regulate thoughts and actions during goal-directed behaviours [12, 13]. It is a complex cognitive concept including attention, inhibition, working memory (WM), cognitive flexibility, reasoning and problem-solving [12]. Deficits in attention and inhibition have been reported in patients with panic disorder (PD) and generalized anxiety disorder (GAD) [6, 14,15,16], though findings are inconsistent [9, 10]. Research on cognitive flexibility in persons with anxiety disorders is divided with studies showing impairments in patients with PD or GAD [6, 15, 18], and lack of such impairments [6, 19]
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