Fear and avoidance of memory loss: associations with cognitive, psychological and lifestyle factors in mid‐ and later life

Abstract

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) are among the most feared conditions. Some level of fear can motivate healthy behaviors. However, intense fears can have the opposite effect, leading to avoidance behaviors such as withdrawal from cognitively or socially demanding activities. In this way, fears and avoidance behaviors have potential to influence modifiable ADRD risk. Here, we investigated if fear and avoidance are associated with cognitive, psychological and lifestyle factors in mid‐ and later life.MethodsParticipants were middle‐aged (n = 188, 40‐59 years, mean = 51.4 ± 5, 52.7% female) and older adults (n = 746, 60‐90 years, mean = 65 ± 7.2, 61.5% female). Fears and avoidance behaviors were measured using Fear and Avoidance of Memory Loss scale. Linear regression examined the contribution of fear and avoidance to cognitive, psychological and lifestyle factors. Mid‐life factors included cognition (COGNITO), stress (Perceived Stress Scale), depressive symptoms (Center for Epidemiologic Studies Depression Scale), loneliness (UCLA Loneliness Scale) and lifestyle activities (Lifetime of Experiences Questionnaire). Later life factors included cognition (MoCA) and depression (Geriatric Depression Scale). Models were adjusted for age, gender, education, ADRD family history and anxiety.ResultsMiddle‐aged and older women reported higher fear compared to men (ps < .028). Older individuals with a family history of ADRD also reported higher fear (p < .001). Avoidance behaviors were significantly associated with worse cognitive performance in later life (β = ‐0.10, p = .020), but not in mid‐life. Greater avoidance in mid‐life was associated with higher stress (β = .83, p = .001), loneliness (β = 1.22, p < .001) and depressive symptoms (β = 1.09, p < .001), and lower engagement in lifestyle activities (β = ‐0.19, p = .02). Avoidance was also associated with depressive symptoms in later life (β = .28, p < .001).ConclusionsAvoidance behaviors were associated with lower engagement in healthy lifestyle activities in mid‐life, worse cognitive performance in later life, and reduced psychological well‐being in both mid‐ and later life. While causation cannot be determined, it is likely that these factors interact recursively over time. Thus, targeting avoidance early on may be beneficial for ADRD risk reduction.