Clinician-Observed Test Anxiety and Its Impact on Neuropsychological Performance in Older Adults

Objective. The aging of the population has led to an increase in dementia diagnoses, highlighting the importance of neuropsychological assessments. However, several factors, including test anxiety, could significantly impact cognitive performance on these tests. While research has established links between test anxiety and poorer tests results in younger populations, the extent of its effects on neuropsychological testing in older adults remains largely unknown. Method. This study used data from the National Alzheimer’s Coordinating Center (NACC) to examine the influence of test anxiety, assessed in 342 cognitively unimpaired older adults during a standardized clinical assessment (Benson Complex Figure Immediate and Recall Copy, Verbal Fluency, Trail Making Test (TMT) part B, WAIS-R Digit Symbol, Craft Story 21 Recall Immediate and Delayed, Number Span Test Forward and Backwards and Multilingual Naming Test (MINT)). The Social Behavioral Observer Checklist was used to categorize participants based on their displaying of self-conscious reactions and anxiety responses during testing. Analyses of covariance assessed differences in performance across the cognitive tasks, adjusting for sex, education, and age. Results. Our study indicated that both anxious and self-conscious individuals performed significantly worse than their counterparts on tasks of delayed recall (Craft Story Recall and Benson Figure recall). Conclusions. These findings suggest that delayed memory is most vulnerable to test anxiety in older adults. Overall, the study emphasizes the relevance of addressing test anxiety in clinical assessments and further investigate the links with anxiety related to dementia to ensure accurate evaluations of cognitive function in older adults.