Task-Based Attentional Control: The Role of Anxiety and Age

Objective Attentional Control Theory (ACT) posits that anxiety impacts cognitive functioning through interference in working memory and processing efficiency, resulting in performance deficits in set-shifting and inhibition. Few studies have examined the effects of anxiety on set-shifting and inhibition in clinical samples or how these relationships might be affected by age. The current study tested whether increased age, elevated anxiety, and their interaction were associated with reduced performance on measures of set-shifting and inhibition. Method Symptom and neuropsychological testing data were obtained from outpatient participants presenting at an academic medical center (N = 521; mean age = 50.39 years, SD = 22.35, range = 18-90; 47.4% female; 78.3% White). The Trail Making Test Difference score was used to assess set-shifting and the Stroop Color-Word Test Interference score was used to assess inhibition. Results After controlling for demographic variables, ADHD diagnosis, depression symptoms, and Mild Cognitive Impairment (MCI), both age and anxiety were significant predictors of set-shifting (beta = 0.45 and beta = 0.18, respectively, ps < 0.001) and inhibition (beta = -0.37, p < 0.001 and beta = -0.19, p = 0.001, respectively). No interaction was found between age and anxiety in the prediction of set-shifting or inhibition. Conclusion Congruent with ACT, anxiety was associated with worse performance on measures of set-shifting and inhibition. Older age was an independent predictor of worse set-shifting and inhibition but did not moderate the relationship between anxiety and attentional control, suggesting that anxiety adversely affected working memory and processing efficiency equivalently across the adult lifespan. The results highlight the importance of anxiety assessment in neuropsychological evaluation in patients of all ages.