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Objective: The aim of the study was to empirically investigate the hypothesis that anxiety in the elderly, secondary to loss of memory, predicts future cognitive decline., Method: The participants were 137 elderly subjects with no depression or cognitive impairment from a community geriatric assessment unit, 45% with anxiety. In addition to demographic characteristics, cognitive status was assessed using the Mini Mental State Examination; depression was assessed by Tucker's short Interviewer-Assisted Depression Rating Scale; anxiety by Sinoff's Short Anxiety Screening Test and Activities of Daily Living function by Shah's modified Barthel's Index., Results: At follow-up 37 persons had dropped out, leaving 100 participants for final analysis. Mean re-examination time was 3.2 years with no group differences. The mean MMSE and modified Barthel scores decreased significantly more in those with anxiety. A relative risk of 3.96 for developing future cognitive impairment was found. Regression analysis showed that only anxiety was a significant predictor of cognitive decline. By path analysis, a more parsimonious model showed anxiety to have both a direct and an indirect effect on predicting future cognitive decline, and that the effect of loss of memory on cognitive decline was via anxiety., Conclusions: Anxiety is inter-related and inseparable with loss of memory and its presence is a strong predictor for future cognitive decline, directly or indirectly via depression. It appears that loss of memory is the initial problem with consequent development of anxiety. Therefore, anxiety, like depression, is probably an early predictor of future cognitive decline and even possible future cognitive impairment., (Copyright 2003 John Wiley & Sons, Ltd.)

Introduction: Depression in the elderly is frequently detected by screening instruments and often accompanied by anxiety. We set out to study if anxiety will affect the ability to detect depression by a screening instrument., Objective: To validate the short Zung depression rating scale in Israeli elderly and to study the affect of anxiety on its validity., Design: The short Zung was validated against a psychiatric evaluation, in a geriatric inpatient and outpatient service. The overall validity was determined, as well as for subgroups of sufferers and non-sufferers of anxiety., Setting: An urban geriatric service in Israel., Patients: 150 medical inpatients and outpatients, aged 70 years and older., Measures: Psychiatric evaluation of modified Anxiety Disorders Interview Schedule for DSM-IV as criterion standard for anxiety and depression and short Zung instrument for depression., Results: By criterion validity, 60% suffered from depression. The overall validity of the short Zung was high (sensitivity 71.1%, specificity 88.3%, PPV 90.1%, NPV 67.1%). The validity for those not suffering from anxiety was good (sensitivity 71.1%, specificity 90.2%, PPV 84.4%, NPV 80.7%). In those with anxiety, sensitivity, specificity and PPV were high (71.2%, 77.8%, 94.9% respectively), although the specificity was less than in non-suffers. However major difference was in the NPV rate being much lower (31.8%)., Conclusion: The short Zung, an easily administered instrument for detecting depression, is also valid in the Israeli elderly. However, anxiety limits the usefulness of this instrument in correctly ruling out depression. The clinician must be aware, therefore, that those suffering from anxiety may score negatively for depression on a screening instrument, such as the short Zung., (Copyright 2002 John Wiley & Sons, Ltd.)

Introduction: The Short Anxiety Screening Test (SAST), an easily administered rating scale, was developed to standardize the detection of anxiety disorder in the elderly, even, and especially, in the presence of depression. The instrument also included somatic complaints, often the manifestation of anxiety in the elderly. Failure to relate to the anxiety component in depression may result in the initial failure of antidepressant therapy., Objective: To validate the SAST in the elderly, especially in the presence of depression., Design: The SAST was validated against a psychiatric evaluation in consecutive patients attending a geriatric service, both inpatient and outpatient. The initial validity of the SAST was tested in all the sample and subsequently in the subgroups of depressed and non-depressed., Setting: An urban geriatric service in Israel., Patients: One hundred and fifty medical inpatients and outpatients, 95 females, aged 70 years and older., Measures: Psychiatric evaluation of modified Anxiety Disorders Interview Schedule for DSM-IV as criterion standard for anxiety and depression, SAST for anxiety and short Zung Interview-Assisted Depression Rating Scale for depression., Results: By the psychiatrist's evaluation, 40.7% suffered from anxiety. Mean SAST scores in the presence and absence of anxiety were significantly different (25.3 and 20.1; p<0.0005). The overall validity of the SAST was high (sensitivity 75.4%, specificity 78.7%). In the presence of depression, sensitivity was 83.3% and specificity 70.5%., Conclusion: The SAST was valid in detecting anxiety in the elderly, as well as in depressed patients. The study proved the usefulness of the SAST in a geriatric assessment programme., (Copyright 1999 John Wiley & Sons, Ltd.)