Background:Adolescence is a critical period for early mental health interventions. Scalable, evidence-based interventions for at-risk adolescents without severe symptoms are limited. We developed a low-intensity, digital programme to train psychological decentering (the ability to disengage from unwanted thoughts, feelings, and memories) as a core psychotherapeutic process for improving mental health. Methods:A two-arm randomised controlled trial compared a 5-week psychological decentering training ('One Step Back': OSB) programme with an active control (CTL) comprising physical and cognitive exercises (May 2021 to November 2022; ISRCTN14329613). Adolescents at-risk of depression were recruited through UK secondary schools, then randomised into trial arms (n = 114, 84% female; M age = 16.8 years, SD = 0.79). The primary outcome was self-reported decentering post-intervention measured using the Experiences Questionnaire. Secondary outcomes included symptoms of depression, anxiety, anger, and socio-emotional functioning, measured using standardised inventories. Analysis of covariance models were calculated, adjusting for baseline scores with an intention-to-treat approach. Findings:OSB was associated with improvements in self-reported decentering scores at post-intervention compared with CTL (M difference = 4.16 [95% CI 1.85-6.51]; p = 0.002; Cohen's d = 0.61). OSB participants reported decreased depression (M difference = -5.54 [95% CI -9.14 to -1.93]; p = 0.003, d = -0.60) and increased well-being (M difference = 4.53 [95% CI 1.21-7.86]; p < 0.001, d = 0.76). Interpretation:Psychological decentering was selectively trained in at-risk adolescents through a brief digital intervention. Training resulted in significant reductions in depression severity. Findings support this low-intensity approach to support adolescents before symptoms worsen. Funding:This project was funded by a Wellcome Strategic Award (Wellcome Ref 104908/Z/14/z; awarded to TD, S-JB, WK, and J. Mark G. Williams) and the UK Medical Council (Grant Reference: MC_UU_00030/5; awarded to TD). The contribution of MPB was partially supported by a Wellcome Trust Active Ingredients in Mental Health Commission. RCK was funded by an Economic and Social Research Council Doctoral Fellowship (ref SUAI/067). SJB is funded by Wellcome (grant number WT107496/Z/15/Z), the MRC, the Jacobs Foundation, the Wellspring Foundation, and the University of Cambridge.

Background:Developmental changes in mental health are mostly mapped between childhood and adolescence or childhood and adulthood. This study maps developmental transitions in mental health profiles from mid- to late-adolescence, exploring how these transitions relate to cognitive function in mid-adolescence. Method:Participants from the IMAGEN cohort (N = 1304) were followed from mid- (14 years) to late (22 years) adolescence. K-means clustering was applied to data from those with elevated mental health problems to identify common profiles of mental health symptoms at each timepoint (n = 784 at 14 years, n = 655 at 22 years). Those with no mental health symptoms formed a comparison group (n = 520 at 14 years, n = 649 at 22 years). Transitions between the groups were mapped across time and related to cognitive function at age 14. Results:Three distinct mental health profiles were identified: presentations of externalising, internalising, or social problems. These were similar in mid- and late adolescence. Externalising problems were more common in mid-adolescence. Persistent externalising and social problems were related to cognitive function in mid-adolescence, but problems that emerged or resolved in late adolescence were not. Conclusions:These data highlight the importance of understanding the developmental context in which mental health symptoms occur, and the cognitive factors linked to their persistence.

Alzheimer’s disease (AD) is highly feared. Fear can prevent individuals from seeking help. By age 65, women’s risk of developing AD is 1 in 5. Women also make up the majority of dementia carers. Therefore, older women may be particularly vulnerable to dementia-related fear and its negative impacts. Across two studies, we examined (1) associations between dementia-related fear and psychosocial functioning and (2) the effectiveness of a brief intervention to reduce fear in older women with and without a dementia family history. Participants were women aged >55 years without a dementia diagnosis. In study 1, participants completed measures of dementia-related fear and memory failures. In study 2, participants were randomized into intervention (psychoeducation, mindful grounding, exposure/behavioral activation) or control groups (psychoeducation, mindful grounding), and completed measures of dementia-related fear, memory failures, depression, social function, and well-being. Study 1 included 285 women (66.1±7.1 years; Fx = 45.6%). Dementia-related fear was positively associated with memory failures ( r = .64, p <.001); fear was elevated in women with a dementia family history ( p = .002, η 2 = .03; Fig. 1A). Study 2 included 58 women (64.6±6.0 years; Fx = 55.2%) randomized to intervention or control groups. Again, dementia-related fear was associated with memory failures ( r = .59, p <.001); fear was elevated in women with a dementia family history ( p = .013, η 2 = .02). Fear was also associated with depression ( r = .52, p <.001), and lower well-being and social participation ( r s>-.59, p s<.001). Fear effects on depression and social participation were stronger for women with a dementia family history ( p s<.027, η 2 s = .11). Fear scores decreased from pre- to post-intervention ( p <.001, η 2 = .06). The biggest reduction was observed for women in the intervention group with a dementia family history ( p = .004, η 2 = .03; Fig. 1B). Older women with a family history of dementia are particularly fearful, and these fears are inversely related to mood, perceived memory functioning, social participation, and well-being. A low-cost, low-intensity intervention can reduce dementia-related fear and may be particularly beneficial for older women with a dementia family history. Targeting dementia-related fear in women has important implications in the era of biomarker disclosure and direct-to-consumer genetic testing.

Identifying shared and distinct profiles, whether in symptom combinations, personality traits, or cognitive abilities, is essential for understanding psychological phenomena, yet doing so requires navigating interrelated theoretical, conceptual, and technical complexities. First, psychological phenomena typically exist along continuous spectra rather than discrete categories, complicating the characterisation of inherently heterogeneous constructs. Second, studying individual differences requires balancing population-level generalisation with person-level interpretability, which is critical for applied science. Third, psychological data often contain missing values, non-linear relationships, and high-dimensional patterns that violate standard statistical assumptions. Commonly used approaches for profile detection fail to address these complexities simultaneously, typically producing oversimplified or difficult-to-interpret results that obscure person-centred patterns. In contrast, Self-Organising Maps (SOMs) offer a powerful, visual, and intuitive solution that addresses these challenges. Despite growing interest, SOMs remain underutilised in psychology, potentially due to a lack of accessible tutorials and clear guidelines tailored to the field. This tutorial introduces SOMs to psychologists without technical backgrounds, emphasising practical implementation. We provide evidence-based guidance for key methodological decisions, accompanied by annotated R code. Using a dataset of depressive symptoms as an illustrative case, we present a complete workflow covering data preprocessing, map initialisation, parameter optimisation, and interpretation. We further discuss advanced SOM extensions relevant to psychological research and highlight key limitations of the method. By providing clear guidance, this tutorial facilitates the adoption of SOMs, advancing nuanced, person-centred analyses that preserve the complexity of psychological phenomena.

Traditional diagnostic and services pathways often overlook the nuanced ways that mental health problems and strengths appear in community settings. Some researchers have therefore used person-centered statistics—or clustering analyses—to identify profiles of socioemotional and behavioral difficulties and well-being traits in preclinical settings such as schools and communities. The objective of this review was to synthesize common adolescent mental health profiles within the literature and examine the state of the science. A systematic review of the literature was completed. Only studies that assessed multiple types of difficulties and/or strengths across community and/or school samples were included. A total of 3960 studies were screened, and k  = 13 were included. Data extraction focused on the types of clusters in each included study, along with associated information like standardized scores, qualitative descriptions, sample size, and demographic characteristics. Data were integrated using a narrative synthesis, and meta-analysis was used to investigate the prevalence of each cluster. Data were reviewed from n  = 103,098 adolescents in 10 countries across 3 World Health Organization (WHO) Regions with a mean (SD) age of 13.72 ± 1.76 years. A total of 59 clusters were identified, and these consisted of 6 main cluster types. The 4 most prevalent cluster types described patterns of Flourishing, Moderate Mental Health, Struggling, and Mental Health Problems. The other 2 cluster types were less prevalent and associated with Languishing or Asymptomatic presentations. Cluster types also differed with respect to the intensity, complexity, and depth of the core profile features. This review describes commonly identified mental health profiles in large representative samples of adolescents. The quality of included studies was generally acceptable, but the literature suffers from variance in how clusters are generated and how mental health is assessed. Overall, this review can guide the development of new classifications of youth mental health and inform early-stage intervention approaches in community settings.

INTRODUCTION:The extent to which Alzheimer's disease (AD) concerns relate to pathological changes in cognitively unimpaired populations is unclear. METHODS:We analyzed screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) study to determine if AD concerns are associated with amyloid burden in cognitively unimpaired older adults, and how they relate to lifestyle. AD concerns were measured using the six-item Concerns about Alzheimer's Disease Questionnaire. Regression estimated the association of AD concerns with amyloid burden, adjusting for covariates. RESULTS:Of 4460 individuals, AD concerns were elevated in women, people with a dementia family history, apolipoprotein E (APOE) ε4 carriers, and individuals who did not meet walking or sleep guidelines. AD concerns were associated with higher amyloid burden (β [95% CI] = 0.002 [0.001-0.003], p = 0.007), with stronger effects in APOE ε4 carriers. DISCUSSION:AD concerns were associated with a core diagnostic AD biomarker. Assessing AD concerns could inform future recruitment strategies. Clinical Registration Trial:: ClinicalTrials.gov: ID NCT02008357. HIGHLIGHTS:Alzheimer's disease (AD) concerns were associated with higher amyloid burden. AD concerns were associated with higher depressive symptoms in apolipoprotein E (APOE) ε4 carriers. Concerns were associated with a lower likelihood of meeting daily walking guidelines. Associations were stronger in APOE ε4 carriers compared to non-carriers.

The COVID-19 pandemic prompted governments worldwide to introduce social distancing measures, including school closures and restrictions on in-person socialising. However, adherence to social distancing was challenging for many - particularly adolescents, for whom social interaction is crucial for development. The current study aimed to identify individual-level influences on adherence to social distancing in a longitudinal sample of adolescents aged 11-20 years in England, who took part in a randomised controlled trial. At baseline, 460 participants completed detailed pre-pandemic assessments, including mental health and well-being, altruism, delayed reward discounting, rejection sensitivity, prosociality and susceptibility to prosocial and anti-social influence. Of these, 205 participants reported their compliance with COVID-19 social distancing rules and attendance at social gatherings between June and August 2020. Bayesian ordinal regression models were used to predict adherence to social distancing from predictors, controlling for age at pandemic, gender, day of assessment, and intervention group. The results indicated that higher levels of prosociality, altruism and lower susceptibility to anti-social influence were associated with higher adherence to social distancing. Pre-pandemic levels of depression, anxiety, delayed reward discounting, rejection sensitivity, conduct problems and emotional awareness were not robustly related to the outcomes. These findings have implications for understanding how adolescents comply with public health guidelines, highlighting the role of social influence and peer norms.

Sustained attention, a key cognitive skill that improves during childhood and adolescence, tends to be worse in some emotional and behavioural disorders. Sustained attention is typically studied in non-affective task contexts; here, we used a novel task to index performance in affective versus neutral contexts across adolescence (N = 465; ages 11-18). We asked whether: (i) performance would be worse in negative versus neutral task contexts; (ii) performance would improve with age; (iii) affective interference would be greater in younger adolescents; (iv) adolescents at risk for depression and higher in anxiety would show overall worse performance; and (v) would show differential performance in negative contexts. Results indicated that participants performed more poorly in negative contexts and showed age-related performance improvements. Those at risk of depression performed more poorly than those at lower risk. However, there was no difference between groups as a result of affective context. For anxiety there was no difference in performance as a function of severity. However, those with higher anxiety showed less variance in their reaction times to negative stimuli than those with lower anxiety. One interpretation is that moderate levels of emotional arousal associated with anxiety make individuals less susceptible to the distracting effects of negative stimuli.

People exhibit marked individual variation in their ability to exercise cognitive control in affectively charged situations. Affective control is typically assessed in laboratory settings by comparing performance in carefully constructed executive tasks performed in both affectively neutral and affectively charged contexts. There is some evidence that affective control undergoes significant improvement throughout adolescence, though it is unclear how adolescents deemed at risk of developing depression exercise affective control despite poor affective control being identified as a contributing factor to ongoing mental ill health in adulthood. The present study therefore investigated affective control in a large (n = 425) sample of adolescents (aged 11-18 years) collected from 2016 to 2018. A simultaneous visuospatial search and written storage working memory (WM) capacity task was carried out to examine affective control, using affectively neutral and affectively negative social images as the task-irrelevant distractors. Overall, WM capacity increased as a function of age across both affective conditions. Moreover, we report a significant difference between affective conditions, with WM capacity slightly lower during trials with affectively negative social scenes, relative to neutral. Performance in each condition and the performance "cost" for completing the task in negative relative to neutral conditions was not modulated by depressive symptoms. Furthermore, age did not predict performance cost, irrespective of depressive symptoms. These findings suggest that WM capacity is relatively robust against socioaffective contexts and mood in adolescents.

People with chronic pain often fear and avoid movements and activities that were never paired with pain. Safe movements may be avoided if they share some semantic relationship with an actual pain-associated movement. This study investigated whether pain-associated operant responses (movements) can become categorically associated with perceptually dissimilar responses, thus motivating avoidance of new classes of safe movements-a phenomenon known as category-based avoidance generalization. Using a robotic arm, 2 groups were trained to categorize arm movements in different ways. Subsequently, the groups learned through operant conditioning that an arm movement from one of the categories was paired with a high probability of pain, whereas the others were paired with either a medium probability of pain or no pain (acquisition phase). Self-reported pain-related fear and pain expectancy were collected as indices of fear learning. During a final generalization test phase, the movements categorically related to those from the acquisition phase were made available but in the absence of pain. Results showed that the generalization of outcome measures depended on the categorical connections between arm movements, ie, the groups avoided and feared the novel generalization movement categorically related to the pain-associated acquisition movement, depending on how they had previously learned to categorize the movements. This suggests that operant pain-related avoidance can generalize to safe behaviors, which are not perceptually, but categorically, similar to a pain-associated behavior. This form of pain-related avoidance generalization is problematic because category-based relations can be extremely wide reaching and idiosyncratic. Thus, category-based generalization of operant pain-related avoidance merits further investigation.

Mindfulness training programmes have shown to encourage prosocial behaviours and reduce antisocial tendencies in adolescents. However, less is known about whether training affects susceptibility to prosocial and antisocial influence. The current study investigated the effect of mindfulness training (compared with an active control) on self-reported prosocial and antisocial tendencies and susceptibility to prosocial and antisocial influence. 465 adolescents aged 11-16 years were randomly allocated to one of two training programmes. Pre- and post-training, participants completed a social influence task. Self-reported likelihood of engaging in prosocial and antisocial behaviours did not change post-training, and regardless of training group, participants showed a higher propensity for prosocial influence than for antisocial influence. Finally, participants were less influenced by antisocial ratings following both training programmes.

The COVID-19 pandemic prompted governments worldwide to introduce social distancing measures, including school closures and restrictions on in-person socialising. However, adherence to social distancing was challenging for many, and particularly for adolescents, for whom social interaction is crucial for development. The current study aimed to identify individual-level predictors of adherence to social distancing in a longitudinal sample of 460 adolescents aged 11-20 years. Participants completed detailed pre-pandemic assessments, including mental health and well-being, altruism, delayed reward discounting, rejection sensitivity, prosociality and susceptibility to prosocial and anti-social influence. Bayesian ordinal regression models were used to predict adherence to social distancing from predictors. The results indicated that higher levels of prosociality, altruism and lower susceptibility to anti-social influence were associated with higher adherence to social distancing. These findings have implications for understanding how adolescents comply with public health guidelines, highlighting the role of social influence and peer norms.

Fear of Alzheimer’s disease and related dementias (ADRD) is a growing concern among older adults. High levels of fear are associated with poorer health outcomes, lower levels of psychological well-being, and the perpetuation of harmful cognitive-behavioral cycles that can potentially hasten cognitive decline. Interventions that disrupt these cycles could bring both immediate and long-term benefits for reducing ADRD-related fears. Given the projected increase in the number of people living with ADRD and accompanying fears, effective interventions are needed to address the emotional needs of older adults. We evaluated a brief psychological intervention aimed at promoting adaptive coping in older adults with heightened ADRD-related fear and examined its effects on broader health outcomes. Eighty-one older adults experiencing heightened ADRD-related fear were recruited to participate in a 3-week online intervention aimed at reducing fear (primary outcome) and improving secondary health-related outcomes (i.e., anxiety, depression, social function). Participants were randomly assigned to REFRAME or active comparison group. Both groups completed psychoeducation and mindfulness activities designed to reduce fear. The REFRAME group completed an additional behavioral activation module designed to disrupt patterns of avoidant behavioral coping. Participants completed measures at baseline, weeks 1-3 of the intervention, post-intervention, and 4-week follow-up. Outcomes were analyzed using linear mixed effects models. Participants ranged from 55 to 90 years, (M = 65.4, SD = 7.1). Intervention adherence was high (>75%) across both groups. ADRD-related fear decreased significantly over time in both groups. Anxiety, depression, and self-reported memory failures also decreased significantly in both groups, while social function and well-being improved. The REFRAME group exhibited a greater reduction in depression compared to the control group. Our brief psychological intervention had positive effects on ADRD-related fear among older adults. However, further research is needed to determine the long-term benefits and their effectiveness in at-risk populations (e.g., people with a family history of dementia), as well as the acceptability of this intervention in clinical settings. These findings highlight the potential benefits of disrupting harmful cognitive-behavioral cycles, as this may encourage older adults to stay engaged in healthy behaviors for longer, ultimately improving their quality of life.

Background Alzheimer’s disease and related dementias (ADRD) are among the most feared age-related conditions. The aim of this study was to evaluate a brief psychological intervention to promote adaptive coping in older adults experiencing heightened fear of ADRD and investigate positive downstream effects on health-related secondary outcomes, including frequency of reported memory failures, psychosocial functioning, and quality of life. Methods Eighty-one older adults were recruited and randomized into REFRAME or active control intervention arms. Both groups received psycho-education and training in mindful monitoring of fears related to ADRD. The REFRAME group received an additional behavioral activation component intended to disrupt maladaptive avoidant coping (i.e., avoidance) strategies. Both groups completed 3-weeks of intervention exercises with accompanying questionnaires (baseline, mid- and post-intervention and 4-week follow-up). Results Adherence was strong (> 75%). We observed a significant reduction in ADRD-related fear and avoidance in both groups. Significant reductions were also observed for frequency of self-reported memory failures, anxiety, and depression. Depression was significantly reduced in the REFRAME group compared to the control group. Significant increases in participants’ ability to participate in social activities and well-being were also observed. Conclusions Findings suggest that a brief psychological intervention can mitigate ADRD-related fears and avoidant coping in older adults, and that benefits extend to broader health-related outcomes including anxiety, depression, social functioning, and well-being. Addressing ADRD-related fear has implications for healthy aging and risk reduction, as individuals may be more likely to engage in activities that are protective against ADRD but were previously avoided. Trial registration : https://clinicaltrials.gov/ct2/show/NCT04821960 .

This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.

IntroductionAlzheimer's disease and related dementias (ADRD) are among the most feared conditions. However, research around ADRD-specific fear and avoidance behaviors is lacking. Here, we validated a novel measure of fear and avoidance specific to memory loss, the Fear and Avoidance of Memory Loss (FAM) scale, and examined associations between fear avoidance and psychosocial functioning in older adults. MethodsWe assessed FAM Scale internal reliability and concurrent validity, and candidate subscales across two samples (total N = 813). We then examined associations between fear avoidance and memory performance, anxiety, depressive symptoms, sleep, social functioning, and quality of life. ResultsWe identified two subscales: fear and avoidance, which yielded strong psychometric validity. Higher fear was associated with memory failures and sleep disturbance. Higher avoidance was associated with memory failures, poorer verbal memory, reduced social functioning, and quality of life. DiscussionWe present the first measure of fear avoidance specific to memory loss. We propose that targeting fear avoidance can promote ADRD risk reduction and resiliency.

Over half of psychiatric disorders of behaviour, mood, and emotion begin before the age of 15. Thus, development of emotional regulation skills to cope with psycho-social stressors is imperative to reduce risk of adolescent-onset mental health difficulties. Psychological decentering, a self-reflective capacity through which distressing thoughts, feelings, and memories, are re-perceived from an observer perspective, could be one such skill. However, questions remain about how decentering relates to age, mental health and emotion regulation, and cognitive processes such as executive control and social cognition. Adolescents in Cambridge and London (Mage = 17.4(1.77), N = 904) completed an online battery of mental health and emotional regulation questionnaires and two cognitive tasks: an affective cognitive control task, the Emotional Stop Signal Task (ESST), and a physical perspective-taking task, the Own Body Task (OBT). Multiple linear regression was used to examine associations between a widely used measure of decentering, the Experiences Questionnaire (EQ), and: age and gender, mental health, emotion regulation, affective executive control, and perspective-taking. Higher self-reported decentering was significantly associated with older age. Higher decentering was also associated with fewer symptoms of anxiety and depression, better psychological wellbeing, more frequent use of emotion regulation strategies, and fewer difficulties with emotion regulation. Decentering was not associated with affective executive control, but better ability to decenter was significantly associated with fewer commission errors on the OBT. This research bolsters evidence of associations between decentering and broader emotion regulation and psychological wellbeing, and provides an indication that decentering may be driven by social cognitive mechanisms involved in physical perspective taking, rather than executive control processes such as inhibition. Understanding associated cognitive processes may provide direction of how to reinforce decentering, and improve psychological interventions of which decentering is a key component.

Early adolescence is characterized by rapid changes in executive function and increased vulnerability to internalizing difficulties. The aim of this study was to explore whether internalizing symptoms are stable across early adolescence and to identify possible links with executive function. Using data from the Adolescent Brain and Cognitive Development Study (ABCD), we identified four dimensions of internalizing symptoms from item-level ratings on the Child Behavior Checklist at ages 10 (n = 10,841) and 12 (n = 5,846), with an invariant factor structure across time. These dimensions corresponded to anxiety, depression, withdrawal, and somatic problems. We then examined associations between these dimensions and three aspects of executive function at age 10 measured by the NIH Toolbox: inhibition, shifting and working memory. Worse shifting and inhibition at age 10 was associated with elevated symptoms of anxiety and withdrawal cross-sectionally, while poor inhibition was also uniquely associated with symptoms of depression. Longitudinal associations were more limited: Worse inhibition at age 10 predicted greater symptoms of withdrawal at age 12, while worse shifting predicted fewer symptoms of anxiety 2 years later. These findings suggest that poor executive function in early adolescence is associated with greater internalizing difficulties and poor inhibition may contribute to later social withdrawal.

Evidence concerning the impact of fear of memory decline on health-related outcomes is limited. To determine the relationship between fear-avoidance of memory decline, quality of life and subjective memory in older adults using a novel scale to measure fear of memory decline. Sixty-seven older adults (59-81 years) completed a 23-item self-report questionnaire designed to capture experiential, cognitive and behavioral components of fear of memory decline, known as the fear and avoidance of memory decline (FAM) scale. Memory performance was assessed using the Wechsler Memory Scale (WMS-IV) and the Memory Failures Scale (MFS). General anxiety was assessed using the Depression, Anxiety and Stress Scales (DASS) and the Geriatric Anxiety Inventory (GAI). Quality of life was assessed using the Older Person’s Quality of Life scale (OPQOL-35). The FAM scale demonstrated good reliability and validity. Three latent factors were observed including: (1) fear-avoidance, (2) problematic beliefs and (3) resilience. After adjusting for age, education, memory performance and general anxiety, higher fear-avoidance predicted lower quality of life (p=.021) and increased memory failures (p=.022). Increased fear of memory decline predicts lower quality of life and subjective memory failures in healthy older adults. Based on these findings, we propose a preliminary fear-avoidance model that explains the development and maintenance of dementia-related functional disability in terms of psychological processes.

Dementia is one of the most feared diseases associated with aging. Although some level of fear can motivate protective strategies, too much fear can be harmful and maladaptive. We examined fear and avoidance of memory loss and their relationship to psychosocial and lifestyle factors associated with dementia risk in a community-dwelling sample of older adults. Participants were 230 adults (112 female) aged 55 years and older (61.3 ± 5.2). Questionnaires were administered to measure fear and avoidance of memory loss, perceived memory failures, depression, sleep disturbance, engagement in social activities and quality of life. We hypothesized that fear and avoidance of memory loss would positively predict perceived memory failures, depressive symptoms and sleep disturbance, and negatively predict social engagement and quality of life. Fear and avoidance of memory loss did not significantly differ by age or sex. People with a family history of dementia reported higher fear ( p s < .02, ds = .4), but not avoidance scores. Fear scores were significantly associated with increased self-reported memory failures and sleep disturbance, and lower quality of life and social functioning, after adjusting for anxiety and memory performance ( β s > .8, p s < .03). Inclusion of avoidance scores improved the predictive power of all models except sleep; avoidance was associated with reduced quality of life and social functioning, and increased memory failures and depression ( β s > .9, p s < .03). Fearful anticipation and avoidance of memory loss is associated with poorer psychosocial functioning and quality of life. Based on these results, we propose a model whereby excessive fear of memory loss motivates withdrawal from social and cognitively demanding activities that can protect against and compensate for dementia risk. Findings have practical implications for psychological and lifestyle interventions, which could allay multiple modifiable risk factor pathways.