Anxiety symptoms bias memory assessment in older adults

M. W. Williams, A. M. Kueider, N. O. Dmitrieva, J. J. Manly, C. F. Pieper, S. P. Verney, L. E. Gibbons

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Older adults with anxiety and/or depression experience additional memory dysfunction beyond that of the normal aging process. However, few studies have examined test bias in memory assessments due to anxiety and/or depressive symptoms. The current study investigated the influence of self-reported symptoms of anxiety and depression on the measurement equivalence of memory tests in older adults. Method: This is a secondary analysis of the Advanced Cognitive Training for Independent and Vital Elderly dataset, a randomized controlled trial of community-dwelling older adults. Baseline data were included in this study (n = 2802). Multiple indicators multiple causes modeling was employed to assess for measurement equivalence, differential item functioning (DIF), in memory tests. Results: The DIF was present for anxiety symptoms but not for depressive symptoms, such that higher anxiety placed older adults at a disadvantage on measures of memory performance. Analysis of DIF impact showed that compared with participants scoring in the bottom quartile of anxious symptoms, participants in the upper quartile exhibited memory performance scores that were 0.26 standard deviation lower. Conclusion: Anxious but not depressive symptoms introduce test bias into the measurement of memory in older adults. This indicates that memory models for research and clinical purposes should account for the direct relationship between anxiety symptoms and memory tests in addition to the true relationship between anxiety symptoms and memory construct. These findings support routine assessments of anxiety symptoms among older adults in settings in which cognitive testing is being conducted.

Original languageEnglish (US)
Pages (from-to)983-990
Number of pages8
JournalInternational Journal of Geriatric Psychiatry
Issue number9
StatePublished - Sep 2017


  • DIF
  • MIMIC modeling
  • anxiety
  • memory
  • older adults

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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