通讯作者: 吴向平, wxp029@126.com

DOI：10.12201/bmr.202602.00100

Research Progress on Anxiety Disorders in the Elderly and Their Relationship with Aging

• 摘要：老年焦虑障碍是晚年常见的心理健康问题，但因临床识别不足，其实际负担可能被低估。该障碍与认知衰退加速、共病风险增加及死亡率上升密切相关，已成为重要的公共卫生挑战。研究显示，其发病机制涉及衰老相关的多层面改变：在神经生物学层面，包括大脑关键区域（如杏仁核-前额叶皮层环路）的结构重塑与神经退行性变，以及GABA、谷氨酸和5-羟色胺等神经递质系统的功能衰退；在内分泌免疫层面，性激素波动、慢性低度炎症状态（炎性衰老）均参与调控焦虑易感性；遗传与表观遗传研究亦提示，衰老可修饰基因对焦虑表型的影响，并存在表观遗传年龄加速现象。此外，心理社会因素，如孤独感、对衰老的负面认知及年龄歧视等，也在焦虑发生发展中起关键中介作用。针对老年患者的治疗需个体化调整：药物治疗应充分考虑药代动力学改变与副作用风险；心理治疗（如认知行为疗法）需结合体育锻炼或技术辅助进行优化，以改善疗效。未来研究应整合神经生物学与心理社会视角，深入探索衰老特异性机制，并发展针对“炎性衰老”等核心通路的新型干预策略，以实现对老年焦虑障碍的更有效防治。

  关键词： 老年焦虑障碍; 衰老; 神经生物学机制; 心理社会因素; 治疗

   

  Abstract: Anxiety disorders in older adults represent a prevalent mental health issue in late life; however, their true burden is likely underestimated due to inadequate clinical detection. These disorders are closely associated with accelerated cognitive decline, increased risk of comorbidities, and higher mortality rates, posing a significant public health challenge. Research indicates that their pathogenesis involves multifaceted changes related to aging. At the neurobiological level, this includes structural remodeling and neurodegeneration in key brain regions (e.g., the amygdala-prefrontal cortex circuit), as well as functional decline in neurotransmitter systems such as GABA, glutamate, and serotonin. In the endocrine-immune domain, factors like sex hormone fluctuations and a state of chronic low-grade inflammation (inflammaging) contribute to regulating anxiety susceptibility. Genetic and epigenetic studies also suggest that aging can modify the influence of genes on anxiety phenotypes and is accompanied by epigenetic age acceleration. Furthermore, psychosocial factors such as loneliness, negative perceptions of aging, and ageism play crucial mediating roles in the development and progression of anxiety. Treatment for elderly patients requires individualized adaptation: pharmacological therapy must carefully consider age-related pharmacokinetic changes and potential side effect risks, while psychotherapy (e.g., Cognitive Behavioral Therapy) should be optimized, potentially by integrating physical exercise or technological assistance, to enhance efficacy. Future research should integrate neurobiological and psychosocial perspectives to further elucidate aging-specific mechanisms and develop novel intervention strategies targeting core pathways such as inflammaging, aiming to achieve more effective prevention and treatment of anxiety disorders in the elderly.

  Key words: Anxiety disorders in the elderly; Aging; Neurobiological mechanisms; Psychosocial factorsTreatment; 

  提交时间：2026-02-28

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  1	2026-01-29	10.12201/bmr.202602.00100V1	下载

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