Newer biomarkers could evaluate treatment response in older adults in whom anxiety is most likely to have long-term adverse health or cognitive

consequences. These may include HPA axis functioning through cortisol sampling, or genome-wide expression analysis, a powerful high-throughput technology that provides a systems approach for examining complex clinical disease in terms of dynamic changes in gene expression.221 Genome-wide expression analysis assays the current activity level of all transcripts known in humans. Thus, for example, a researcher can determine whether stress results in higher or lower levels of RNA transcripts in peripheral immunological cells.222 Such data, combined with bioinformatic Inhibitors,research,lifescience,medical techniques, allow researchers to infer the functioning of all of the intracellular pathways at a given point in time (ie, at baseline and then after a treatment), as well as their interactions.223,224 Inhibitors,research,lifescience,medical Additionally, as we previously noted, chronic stress hyperactivity (as seen in anxiety disorders) may cause accelerated aging; thus, telomere length measurement, during the

course of a treatment study, might provide a precise and quantitative estimate of benefits of treatment for health and cognition of older adults. Finally, novel Trichostatin A research buy neuroimaging markers might include neurogenesis, functional connectivity, and peripheral Inhibitors,research,lifescience,medical and central inflammation. In all, recent advances in technology in studies of anxiety could increase our precision for measurement, a need most pressing in geriatrics. What we do know: Inhibitors,research,lifescience,medical eight rules for managing anxiety disorders from a lifespan perspective

In this last section, we provide a blueprint for managing older (and equally so, younger) adults with anxiety disorders, based on empirical findings and our own clinical experience. 1. Assessment should Inhibitors,research,lifescience,medical measure severity and provide objective criteria for assessing response, and should assess comorbidity, prior treatment, cognitive status, and need for a medical workup Assessment of anxiety is often overlooked by mental health providers. A helpful introduction to the topic is to ask about stress; eg, “older adults often deal with stress; many how do you feel in times of stress?“ Patients who describe symptoms suggestive of anxiety or worry can then be further queried. Use nondirective questioning to determine the severity of anxiety symptoms, by: (i) level of distress (asking how much the anxiety symptoms bother the patient, what strategies they are trying in order to control or avoid it, and what somatic symptoms they are having); (ii) how much of their time it takes; and (iii) avoidance. Avoidance is a key component of all anxiety disorders yet often is not recognized. For example, older adults may rationalize changes in behavior patterns to perceived poor health or environmental limitations. Inquire about behavioral changes including activities given up or, conversely, intrusive overinvolvement with family members.