Associations between clinician-observed test anxiety and neuropsychological performance in older adults

As dementia diagnoses rise with population aging, understanding factors that influence neuropsychological performance become increasingly important. While research has established links between test anxiety and poorer test results in younger populations, its effects in older adults remain unclear.

A total of 342 cognitively unimpaired older adults from the National Alzheimer's Coordinating Center were included. Participants were categorized according to clinician-observed test anxiety using the Social Behavioral Observer Checklist into Anxious versus Non-anxious groups and Self-conscious versus Non-self-conscious groups. Measures of episodic memory, executive functions, language, and visuospatial abilities were administered. Analyses of covariance tested performance differences, adjusting for sex, education, and age.

Anxious and self-conscious participants performed significantly worse than their counterparts on episodic memory (delayed recall), although effect sizes were small (η² ≈ .02-.04). No significant group differences were observed on other cognitive measures. The association between being Self-conscious during testing and lower episodic memory remained significant when controlled for everyday anxiety and depression symptoms, whereas the association for being Anxious did not.

Findings suggest that clinician-observed test anxiety may have minimal impact on cognitive results in aging. Nonetheless, the specific association between test anxiety and episodic memory performance underscores the need to minimize anxiety during assessments to support accurate diagnosis.