A-98: Ecological Momentary Assessment of Anxiety and Cognitive Function in Older Adults with MCI and Mild ADRD: Evidence for Incremental Validity

Abstract

Objective: In older adults with neurocognitive disorders, retrospective anxiety ratings may be limited by recall bias. We examined whether average EMA-anxiety demonstrated incremental validity over retrospective PROMIS Anxiety in relation to subjective cognitive symptoms and objective neuropsychological performance in older adults with mild cognitive impairment (MCI) or mild Alzheimer’s disease and related dementias (ADRD). Method/Data Selection: Older adults with MCI/mild ADRD enrolled in a randomized controlled trial (N = 124). EMA-anxiety was assessed across a 7-day post-baseline window. Baseline PROMIS Anxiety served as the retrospective comparator. Outcomes included subjective cognitive symptoms on the Quick Dementia Rating System (QDRS) and objective impairment on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Hierarchical regression models tested the variance explained by EMA-anxiety above PROMIS Anxiety, controlling for age, sex, education, and site. Results/Data Synthesis: EMA-anxiety demonstrated significant incremental validity over PROMIS Anxiety for subjective cognitive symptoms on the QDRS (ΔR2 = .13, p < .001; β = .62, 95% CI [.39, .85]). PROMIS Anxiety was not significantly associated with QDRS ratings when controlling for EMA Anxiety (β = .06, ns). Neither EMA-anxiety nor PROMIS Anxiety significantly predicted RBANS performance (EMA ΔR2 = .007, p = .33). Conclusions: EMA-anxiety showed incremental validity over retrospective PROMIS Anxiety for subjective cognitive symptoms, but not for objective neuropsychological performance, in older adults with MCI and mild ADRD. These findings suggest anxiety can be captured with reliability and validity via EMA, and that EMA-rated anxiety might be a more informative rating of anxiety than self-reported anxiety in adults with MCI/mild ADRD.