Cognitive impairment in patients with generalized anxiety disorder : A systematic review and meta-analysis

Abstract: Background: Generalized anxiety disorder (GAD) is characterized by excessive anxiety and is associated with cognitive impairment (CoI) as part of the clinical picture. Long term anxiety can influence cognition negatively, yet there is a limited amount of reviews compiling present research on the association. The first aim of this systematic review was to investigate whether there is a difference in global cognition between individuals suffering from GAD compared to healthy controls (HC). The second aim was to specify which cognitive domains that are mainly affected. Methods: A PubMed search with terms for CoI, cognitive testing and anxiety disorders was made. Studies were reviewed based on predetermined eligibility criteria. The quality and certainty of the studies was evaluated. Data was extracted and categorized based on cognitive domains, meta-analysis was then performed for each domain. Results: Eight studies were included. The mean difference for global cognition was 0.49 points lower (95%CI -0.91,-0.07) in GAD compared to HC. The standard mean difference (SMD) for memory was 0.61 points lower (95%CI -1.20, -0.03), for attention 0.63 points lower (95%CI -1.18,-0.08), for executive function 0.74 points higher (95%CI -0.03,1.51) indicating lower function, for language 0.11 points lower (95%CI -0.38,0.15), and for visuospatial function 0.06 points lower (95%CI -0.76,0.63), all in GAD compared to HC. According to GRADE, the certainty of the results is very low. Conclusion: Individuals with GAD seem to have a statistically significant CoI compared to HC in global cognition, memory and attention. Further research is needed with studies of high methodological quality.