Study on Worry and Brain Connectivity in Older Adults Selected as Editor’s Choice in Journal of Affective Disorders

The paper described below was selected as a Journal of Affective Disorders Editor’s Choice.

Is worry good for you? According to a study focused on anxiety in older adults, and published in the Journal of Affective Disorders, a moderate level of worry can enhance connectivity among brain regions involved in emotion regulation—while excessive worry yields the inverse effect. 

Generalized anxiety disorder is common in older adults but there is much to be learned about the neuropathology of anxiety in late life. Existing studies, which explored the limbic-prefrontal connectivity associated with emotional regulation deficits in generalized anxiety disorder, focus on adults in midlife. 

Carmen Andreescu, MD, the study’s senior author, explained: “Severe worry in older adults is associated with significant medical and cognitive comorbidities, including a higher risk of stroke and of cognitive decline. Thus, deciphering the effect of worry on the aging brain is crucial in order to develop adequate interventions and prevent further decline.”   

To learn more about the effect of worry severity on brain connectivity, researchers including Minjie Wu, PhD, and Dr. Andreescu, from Pitt Psychiatry, examined the functional connectivity of the amygdala and the bed nucleus of stria terminalis (BNST) with the prefrontal cortex while study participants engaged with emotional stimuli. The research team studied 16 older adults with generalized anxiety disorder and 20 healthy control older adults who underwent functional resonance imaging while completing a faces and shapes emotional reactivity task. This paradigm, consisting of five control blocks of shapes and four experimental blocks of emotional faces, is known to reliably engage the limbic and prefrontal brain regions. 

The investigators found that worry severity and connectivity between the amygdala/BNST and the prefrontal cortex were negatively correlated among participants with generalized anxiety disorder, but positively correlated among the healthy control group. Moreover, across all participants, both very low and very high levels of worry were associated with decreased connectivity between the limbic regions and the prefrontal cortex. These findings suggest that moderate worry is associated with maximum engagement of the prefrontal cortex with the amygdala/BNST.

According to Dr. Andreescu, these findings suggest a “Goldilocks effect” of worry severity on emotion regulation brain circuitry (that is, just the right amount of worry is beneficial) which may have implications for response to treatment modalities (such as cognitive behavioral therapy) in older adults with severe worry or generalized anxiety disorder. 

When Worry May Be Good for You: Worry Severity and Limbic-prefrontal Functional Connectivity in Late-life Generalized Anxiety Disorder
Wu M, Mennin DS, Ly M, Karim HT, Banihashemi L, Tudorascu DL, Aizenstein HJ, Andreescu C

Journal of Affective Disorders online July 2019 DOI: