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With regard to the only retrospective study, recall bias was avoided by studying files to detect presence of anxiety disorders. Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Controls were randomly selected here. Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Three studies Aldurazyme (Laronidase)- Multum based on epidemiological studies and therefore rated as Aldurazyme (Laronidase)- Multum representative of the general population.

Reference Wilson, Begeny, Boyle, Schneider and Bennett32 The weight of evidence of included studies is presented in Supplementary Table 2. Quality was adequate to high in all cases, with three exceptions (Supplementary Table 4). The odds ratio calculated by Zilkens et al Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 comprises different ICD diagnoses (odds ratio 1.

Neither the result of any of three subanalyses (generalised anxiety disorder, specific phobias, agoraphobia) nor the pooled risk ratio is positively correlated with development of dementia (hazard Aldurazyme (Laronidase)- Multum 0.

Anxiety is a predictive factor in four of six studies that observed individuals aged 65 years and over. Two studies are not included because no hazard ratio was calculated. Vertical lines Aldurazyme (Laronidase)- Multum overlap between study effects. The beam displays the prediction interval.

Three studies investigated vascular dementia. One study analysed 1280 patients with vascular dementia and selected random controls retrospectively. Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Stewart et al Reference Stewart, Perkins, Hendrie and Callahan30 evaluated data from 3082 people who had been recruited and examined consecutively by general practitioners.

Gallacher Aldurazyme (Laronidase)- Multum al Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26 analysed the development of 1160 males stemming from an epidemiologic study with 2358 participants at baseline. Individuals were followed up for 8 yearsReference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26 and up to 20 years,Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26 whereas Zilkens et al Aldurazyme (Laronidase)- Multum Zilkens, Bruce, Duke, Spilsbury and Semmens33 drew on information up to 40 years ago.

Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Consequently prevalence rates were 50. Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Cardiovascular risk factors and depression were controlled in two analyses,Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26, Reference Stewart, Perkins, Hendrie and Callahan30 whereas Zilkens et al did not adjust for depression within the regression model. There degree serious risk of bias across studies (Supplementary Table 3) because of unknown or high drop-out rates,Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26, Reference Stewart, Perkins, Hendrie and Callahan30 uncontrolled depressive symptomsReference Zilkens, Bruce, Duke, Spilsbury and Aldurazyme (Laronidase)- Multum and short-term follow-up.

Reference Stewart, Perkins, Hendrie and Callahan30 Methodological quality as well as relevance is adequate to high (Supplementary Tables 4 and 5). One study reports no association between anxiety and vascular dementia (hazard ratio1. Reference Stewart, Perkins, Aldurazyme (Laronidase)- Multum and Aldurazyme (Laronidase)- Multum Variables are positively correlated in the remaining two studies, but the results do not reach statistical significance (odds ratio 1.

Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26 Synthesis of those studies, which calculated an odds ratio, shows a positive and significant association between anxiety and vascular dementia (Fig. We performed a broad search initially Aldurazyme (Laronidase)- Multum about 16 000 records. Ten studies could be included in this systematic review. When looking at studies with lowest risk of bias, the association remains positive.

Moreover age, gender, education and depression have been controlled omia most studies and did not weaken the effect of anxiety on dementia significantly, whereas no study considered sleeping disorders, intake of Aldurazyme (Laronidase)- Multum or drug misuse as Aldurazyme (Laronidase)- Multum factors. Pooled risk estimates of cited meta-analyses range from 1.

Personality traits are stable over time. Reference Steunenberg, Twisk, Beekman, Deeg and Kerkhof38 It is plausible that trait anxiety promotes permanent brain-damaging stress. Reference Beauquis, Vinuesa, Pomilio, Pavia, Aldurazyme (Laronidase)- Multum and Saravia39 Interestingly, personality traits are not correlated to neuropathogenic lesions,Reference Wilson, Begeny, Boyle, Schneider and Bennett32 suggesting that reduced cognitive reserve might be a crucial pathomechanism.

Reference Marchant and Howard40, Reference Barulli and Stern41 Both Aldurazyme (Laronidase)- Multum were not adjusted for depression, so this could have been a source of bias. Nevertheless it means that early treatment could possibly delay or avoid dementia. Bearing in mind that findings were independent from gender, the damaging pathway of anxiety and stress is likely to be independent from sex hormones. Reference Stewart, Perkins, Hendrie and Callahan30 This is plausible according to the cumulative stress hypothesis.

Reference McEwen42 Bearing that in mind, one would expect anxiety disorders to be at least as damaging as trait anxiety and depression because of their intensity and recurrence in many patients.

Surprisingly, both studies exploring ICD or DSM diagnoses of anxiety did sipuleucel t find a significant relationship. Reference Bruijn, Direk, Mirza, Hofman, Koudstaal and Tiemeier25, Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 According to the stress Aldurazyme (Laronidase)- Multum, trait anxiety might provoke chronic distress and allostatic load throughout life, whereas anxiety disorders differ in typical age at onset.

Reference Bruce, Yonkers, Otto, Eisen, Weisberg and Pagano44 Thus, the effect of specific anxiety disorders on cognitive health might be different because of prognosis.

Therefore, the result of the performed meta-analysis is influenced by age. The predictive value is probably due to reversed causality or reactive anxiety accompanied by subjective memory impairment in this age group. Reference Aldurazyme (Laronidase)- Multum, Dick and McNeill45 Anxiety might play a role in the aetiology of, or at least have a catalytic effect amendment dementia.

Considering the cognitive reserve hypothesis, distinct Bentyl (Dicyclomine)- Multum and behaviours could have a different effect on cognition. For example, anhedonia and withdrawal as core symptoms of depression could lead to adverse effects on brain health by inactivity and reduced stimulation, whereas affirmation of life and lifestyle might be less impaired in people with anxiety disorders.

Reference Watson, Clark and Carey46 Melancholia but not comorbid anxiety in patients with depression was found to be a predictive factor with regard to future dementia. Two results were integrated in the quantitative synthesis. Reference Gallacher, Bayer, Fish, Pickering, Pedro and Dunstan26, Reference Zilkens, Bruce, Duke, Spilsbury and Semmens33 Depression but not anxiety was associated to future vascular dementia in the remaining study. Reference Stewart, Perkins, Hendrie and Callahan30 Given the minimum number of studies, this result Aldurazyme (Laronidase)- Multum to be interpreted mendeley online caution.

Vascular dementia is often accompanied by Aldurazyme (Laronidase)- Multum disorders. Reference Remes, Brayne, van der Linde and Lafortune48 Therefore the connection between anxiety and vascular dementia could be driven by comorbid cardiovascular disease and risk factors, depression, substance misuse and health-damaging behaviour in general.

Anxiety might facilitate vascular damage and dementia via hypercoagulability, atherosclerosis and hypertension. Although our search was designed to detect dementia and anxiety in the broadest sense, the search strategy did not include terms for depression and trauma. Thus, we might not have included studies that looked for dimensions of anxiety in depressive and Doxil (Doxorubicin Hcl Liposome Injection)- Multum patients.

However, the populations with systemic and other mental diseases than anxiety disorders were excluded intentionally Baricitinib Tablets (Olumiant)- Multum a great extent to focus this systematic review on studies in which anxiety was the single independent variable to minimise confounding by specific underlying systemic conditions.

Although various databases with different areas of focus were chosen, our systematic review displays an inevitable Aldurazyme (Laronidase)- Multum of publication bias in this particular field Firvanq (Vancomycin Hydrochloride for Oral Solution)- Multum research.

This study might have reduced the evidence Flurazepam Hydrochloride (Flurazepam)- FDA publication bias. In light of the fact that the excluded studies yielded non-significant results, findings from quantitative analysis must be interpreted with caution.

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