Older and wiser? The neural correlates of worry induction and reappraisal in older adults.

Severe worry is a transdiagnostic, highly prevalent symptom, difficult to treat and associated with significant morbidity in late life. Understanding the neural correlates of worry induction and reappraisal in older adults is key to developing novel treatments. We recruited 124 older adults ( ≥ 50 years old) with varying worry severity and clinical comorbidity (27% generalized anxiety disorder, 23% depressive disorders). Participants completed a naturalistic worry induction and reappraisal task during functional magnetic resonance imaging (fMRI), and they rated worry severity after each condition. We compared conditions using voxel-wise paired t-tests and conducted k-means clustering on regional activation to identify groups. We predicted the clinical features of cluster groupings using elastic net regression. Worry induction activated regions in default mode network, executive control network, anterior salience network, visual cortex, and subcortical regions (including basal ganglia and thalamus). Reappraisal was characterized by a broader activation of the cingulate and prefrontal cortex. Activity during worry induction clustered into a largely hyperactive compared to a largely hypoactive group. We accurately predicted clusters using elastic net regression and found the hypoactive group exhibited higher reflection, lower in-scanner worry, and greater cumulative illness compared to hyperactive group. We expand our previous work on neural correlates of worry induction and reappraisal, and we identify two novel neuro-endophenotypes: one with neural hyperactivation and high acute worry and another with relatively lower worry, higher reflection and neural hypoactivation. These results identify potential target networks in chronic severe worriers that may be amenable to neuromodulation. "By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and third by experience, which is the bitterest." -Confucius.