Longitudinal Association Between Generalized Anxiety Disorder and Cognitive Change: A Meta-Analysis

Objective This study aimed to systematically evaluate the longitudinal relationship between generalized anxiety disorder (GAD) and cognitive function changes. Specifically, we examined whether GAD is an independent risk factor for sustained cognitive decline and explored the potential effects of cognitive behavioral therapy (CBT) on cognitive and emotional outcomes.Methods We conducted a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library for eligible longitudinal studies and randomized controlled trials published up to January 20, 2025. Meta-analyses were performed using RevMan 5.4.1. Effect sizes were estimated using mean differences (MD) and 95% confidence intervals. Heterogeneity was assessed with the I2 statistic. Sensitivity analyses and publication bias assessments were also conducted.Results A total of 13 studies were included. The results showed no significant differences between GAD patients and controls on memory and attention subscores of the dementia rating scale (p>0.05). Total error scores also showed no significant difference. Subgroup analyses indicated that GAD patients receiving CBT demonstrated greater improvement in clinical symptoms than those receiving non-cognitive interventions (MD=-4.39, p=0.0004). Beck Depression Inventory score differences were statistically significant, while Penn State Worry Questionnaire score differences were not.Conclusion This meta-analysis suggests that while GAD does not show consistent evidence of sustained cognitive decline, CBT may be associated with improvement in emotional symptoms. By integrating longitudinal data with treatment outcomes, this study offers preliminary insights into the potential indirect cognitive benefits of psychotherapy in GAD.