journal articles
COMBINED EFFECT OF ANXIETY DISORDER AND INSOMNIA ON THE RISK OF INCIDENT ADRD DIAGNOSIS
SangNam Ahn, Joanne Salas, Jinmyoung Cho, Jeffrey F. Scherrer
BACKGROUND: Anxiety disorders and insomnia are common modifiable conditions in older adults, but their independent and combined effects on the risk of incident Alzheimer’s disease and related dementias (ADRD) remain unclear.
OBJECTIVES: To estimate the independent and combined associations of anxiety disorders and insomnia with the risk of incident ADRD.
DESIGN: Retrospective cohort study using an intention-to-treat approach with a 10-year follow-up period (2014–2023).
SETTING: De-identified electronic health record (EHR) data from 70 participating healthcare organizations within the TriNetX Research Network.
PARTICIPANTS: Adults aged ≥50 years without prior dementia who had regular ambulatory care during a three-year baseline period (n = 1,868,790).
MEASUREMENTS: Anxiety and insomnia were identified using ICD-based algorithms and categorized into four exposure groups: neither condition, anxiety only, insomnia only, and both. Incident ADRD was defined by two or more diagnostic codes within 12 months. Entropy balancing controlled for confounding, and weighted Cox proportional hazards models estimated hazard ratios (HRs).
RESULTS: At baseline, 4.1% had anxiety only, 3.8% had insomnia only, and 1.1% had both. Over follow-up, 2.3% developed ADRD. In weighted models, insomnia alone (HR: 1.12; 95% CI: 1.06–1.19), anxiety alone (HR: 1.49; 95% CI: 1.39–1.60), and co-occurring anxiety and insomnia (HR: 1.31; 95% CI: 1.06–1.62) were each associated with higher ADRD risk compared with neither condition. No significant effect modification by age, sex, or race was observed.
CONCLUSIONS: Anxiety and insomnia independently increase ADRD risk, though insomnia's contribution is very modest compared to the primary association demonstrated by anxiety. Co-occurrence does not confer additional risk beyond anxiety alone. Clinically, routine screening and treatment of anxiety and sleep disturbances represent actionable, broadly applicable strategies for ADRD prevention and healthy cognitive aging.
CITATION:
SangNam Ahn ; Joanne Salas ; Jinmyoung Cho ; Jeffrey F. Scherrer (2025): Combined effect of anxiety disorder and insomnia on the risk of incident ADRD diagnosis. The Journal of Prevention of Alzheimer’s Disease (JPAD). https://doi.org/10.1016/j.tjpad.2026.100621