Executive Dysfunction Across Anxiety Severity Level: Evidence for Cognitive Plateau

Anxiety disorders are increasingly recognized as involving neurocognitive impairments in executive functioning, including working memory, inhibitory control, and cognitive flexibility. However, Indian research has predominantly emphasized emotional and behavioural manifestations, leaving the neuropsychological correlates of anxiety severity underexplored.

To investigate the relationship and differences in executive functioning among individuals with varying levels of anxiety.

A cross-sectional study was conducted with 60 patients, classified into mild, moderate, or severe anxiety using the PROMIS Anxiety-Adult Short Form. Neuropsychological assessment included the Wechsler Memory Scale (WMI), Stroop Test (inhibitory control), and Wisconsin Card Sorting Test (conceptual processing). Data were analysed using ANOVA, post hoc comparisons, chi-square tests, Pearson's correlations, and linear regression. Ethical approval and informed consent were obtained.

Significant group differences emerged across all domains (WMI: F = 6.87, p = .002; Stroop: F = 13.09, p < .001; WCST: F = 17.72, p < .001). Post hoc tests showed superior performance in the mild group relative to moderate and severe groups, with no significant differences between the latter two. Anxiety severity correlated negatively with executive functioning (r = -0.45 to -0.61, p < .01). Regression analyses confirmed severity as a significant predictor, explaining 20%-37% of variance in executive performance.

Executive dysfunction worsens with increasing anxiety severity, with cognitive decline plateauing between moderate and severe levels. Strong correlations highlight severity as a critical determinant of working memory, inhibitory control, and conceptual processing. Findings underscore the need to integrate neuropsychological assessment and cognitive rehabilitation into anxiety management in Indian clinical settings.