Anxiety and Depressive Symptoms and Cortical Amyloid-β Burden in Cognitively Unimpaired Older Adults

Abstract

BACKGROUND: There is evidence of relationships between behavioral symptoms and increased risk for Alzheimer's Disease and/or Alzheimer's Disease biomarkers. However, the nature of this relationship is currently unknown. OBJECTIVES: To evaluate the relationship between anxiety and depressive symptoms and amyloid-beta deposition in cognitively unimpaired older adults, and to assess mediating effects of either objective or subjective cognitive skills. DESIGN: Cross-sectional analysis of screening data from participants enrolled in the Anti- Amyloid Treatment in Asymptomatic Alzheimer Disease (A4) Study (ClinicalTrials.gov Identifier: NCT02008357) SETTING: Data analysis PARTICIPANTS: 4492 cognitively unimpaired adults, age 65-85, enrolled in the Anti- Amyloid Treatment in Asymptomatic Alzheimer Disease (A4) Study MEASUREMENTS: We used linear regression to estimate the associations between amyloid-beta standard uptake value ratio (SUVR) and Geriatric Depression Scale (GDS) and State Trait Anxiety Inventory (STAI) scores while adjusting for potential confounding factors as well as for Cognitive Function Index (CFI) or Preclinical Alzheimer's Cognitive Composite (PACC) scores as possible mediational variables. RESULTS: 4399 subjects with complete covariates were included (mean age: 71.3, 59% female), GDS ranged 0-13 (mean: 1.0), and STAI ranged 6-24 (mean: 9.9). Amyloid-beta SUVR was modestly associated with STAI; mean STAI score was estimated to be 0.275 points higher (95% CI: 0.038, 0.526; p-value = 0.023) for each 0.5-point increase in cortical amyloid-beta SUVR. Subjective cognitive decline (CFI) attenuated the relationship between SUVR and STAI, while objective cognitive function (PACC) did not. No statistically significant relationship between SUVR and GDS was observed (p = 0.326). CONCLUSIONS: In cognitively unimpaired adults with low levels of depression and anxiety, cortical amyloid-beta deposition is associated with anxiety but not depressive symptoms. Attenuation of this relationship by subjective cognitive difficulties suggests that anxiety may be partly due to such a perception resulting from cortical amyloid-beta deposition.