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J Geriatr Psychiatry Neurol. 2015 Mar;28(1):57-66. doi: 10.1177/0891988714541871. Epub 2014 Jul 9.

The synergistic effects of anxiety and cerebral hypoperfusion on cognitive dysfunction in older adults with cardiovascular disease.

Author information

  • 1Department of Psychology, Kent State University, Kent, OH, USA
  • 2Department of Psychology, Kent State University, Kent, OH, USA.
  • 3Department of Psychiatry McLean Hospital/Harvard Medical School, Belmont, MA, USA.
  • 4Department of Psychology, Idaho State University, Pocatello, ID, USA.
  • 5Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 6Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA.
  • 7Columbia Teachers College, New York, NY, USA.
  • 8Care New England, Providence, RI, USA.
  • 9Brown University, Departments of Neuroscience and Diagnostic Imaging., Providence, RI, USA.
  • 10Section of Cardiology, Brown University, Providence, RI USA.
  • 11Cognitive Aging and Memory Program, Clinical Translational Research Program, Institute on Aging, University of Florida, Gainesville, FL, USA.
  • 12Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA Department of Psychology, University of Georgia, Athens, GA, USA.



Anxiety is a risk factor for cardiovascular disease (CVD) and is associated with neurocognitive outcomes. The effect of anxiety on brain perfusion in a CVD population has yet to be examined, and no study has investigated the interactive effects of anxiety and cerebral perfusion on cognition.


A total of 55 older adults with CVD completed the Beck Anxiety Inventory (BAI) and underwent arterial spin labeling to quantify cortical perfusion and thickness. Participants were administered the Mini-Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status.


Reduced perfusion predicted poorer cognition and decreased cortical thickness. Higher anxiety score predicted worse memory performance and decreased frontal perfusion. Frontal lobe hypoperfusion combined with increased BAI scores exacerbated poorer MMSE performance.


Higher anxiety may exacerbate the effects of cerebral hypoperfusion on cognitive impairment. Longitudinal studies are needed to confirm our findings and determine whether anxiety treatment improves neurocognitive outcomes in CVD.


anxiety; arterial spin labeling; cardiovascular disease; cerebral blood flow; cerebrovascular disease; cognitive function; magnetic resonance imaging; neuroimaging

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