One option is to conduct a preventive intervention study for late-life anxiety disorders.28 A preventive intervention study could enroll subjects with one or more of these risk factors, probably those with subsyndromal depressive or anxiety symptoms, and manage

them with a stepped-care approach to prevent the onset of an anxiety disorder.29 Such a preventive study could gather biological and behavioral data to elucidate biological, psychological, Inhibitors,research,lifescience,medical and social variables associated with increased likelihood of developing chronic anxiety. Elucidation of such risk signatures could then lead to a second generation of more robust preventive interventions that could target individuals most likely to benefit from prevention and intervene directly on the modifiable risk.30 Such research would be consistent with the National Institute of Mental Health’s vision of “pre-emptive” Inhibitors,research,lifescience,medical and “personalized” mechanistic-based novel intervention development.31 Course Anxiety

disorders are among the most persistent mental health syndromes. The few longitudinal studies that have been carried out Inhibitors,research,lifescience,medical in older adults with anxiety suggest that they tend to be persistent in this age group.32 Anxious older adults in epidemiological and treatment-seeking samples retrospectively report an average duration of 20 years or more, at least in the case of GAD.13,14,33,34 Anxiety’s association with disability is greater with increasing age and it is bidirectional.35 Anxiety increases Inhibitors,research,lifescience,medical disability36

and appears in some studies to be associated with increased mortality risk.37-40 Additionally, significant quality of life impairment and increased burden of health care cost has been noted in GAD in older adults, on a par with that seen in late-life depression.41,42 Perhaps more uniquely in older adults, Inhibitors,research,lifescience,medical data suggest that chronic pathological anxiety is toxic to brain health. Anxiety symptoms or disorders in elderly are associated with accelerated Bortezomib clinical cognitive decline.43-45 Below are some putative mechanisms based on an examination of recent mechanistic research. Chronic psychological distress in older adults results in impairments in cognition46-49 and it is thought that a keymechanism for this relationship involves changes in the hypothalamic-pituitary-adrenal (HPA) axis.50 The HPA axis is a neuroendocrine mediator of stress and its central nervous system (CMS) effects GSK-3 Figure 2. Figure 2. Proposed model of how a biological stress response in late-life anxiety produces cognitive impairment, and how mindfulness-based treatment for late-life anxiety disorders may reverse this cognitive impairment. CRH, corticotropin-releasing hormone; ACTH: … The aging brain is less able to downregulate the HPA axis51-56 and is more vulnerable to physiological insults.57,58 As a result, in older adults, chronic anxiety can cause IIPA axis hyperactivity,59-64 with deleterious effects on memory and CHIR99021 manufacturer executive function.