Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries

Lee Smith, Louis Jacob, Guillermo F. López-Sánchez, Laurie Butler, Yvonne Barnett, Nicola Veronese, Pinar Soysal, Lin Yang, Igor Grabovac, Mark A. Tully, Jae Il Shin, Ai Koyanagi

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Aim: Anxiety may be a risk factor for mild cognitive impairment (MCI) but there is a scarcity of data on this association especially from low- and middle-income countries (LMICs). Thus, we investigated the association between anxiety and MCI among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa), and the mediational effect of sleep problems in this association. Methods: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis, meta-analysis, and mediation analysis were conducted to assess associations. Results: The final sample included 32,715 individuals aged ≥50 years with preservation in functional abilities [mean (standard deviation) age 62.1 (15.6) years; 48.3% males]. Country-wise analysis showed a positive association between anxiety and MCI in all countries (OR 1.35–14.33). The pooled estimate based on meta-analysis with random effects was OR=2.27 (95%CI=1.35–3.83). Sleep problems explained 41.1% of this association. Conclusions: Older adults with anxiety had higher odds for MCI in LMICs. Future studies should examine whether preventing anxiety or addressing anxiety among individuals with MCI can lead to lower risk for dementia onset in LMICs, while the role of sleep problems in this association should be investigated in detail.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalJournal of affective disorders
Publication statusPublished - 2021 Aug 1

Bibliographical note

Funding Information:
This paper uses data from WHO's Study on Global Ageing and Adult Health (SAGE). SAGE is supported by the U.S. National Institute on Aging through Interagency Agreements OGHA 04034785, YA1323–08-CN-0020, Y1-AG-1005–01 and through research grants R01-AG034479 and R21-AG034263.

Publisher Copyright:
© 2021

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries'. Together they form a unique fingerprint.

Cite this