Objectives Anxiety diagnoses occur in 17.1% in people age 65 years and older. Individuals with anxiety may be at a higher risk of the development of probable Alzheimer's disease (AD). Previous literature has suggested that anxiolytic medications may exacerbate the risk of AD development. This study explored anxiolytic medication as a potential moderator of AD risk in older adults. Methods A secondary data analysis of the National Alzheimer's Coordinating Center Uniform Data Set was undertaken, analyzing observations from 12,083 participants with normal cognition at the first visit. Survival analysis was utilized to examine if anxiolytic medication use by those with anxiety and/or APOE ɛ4 moderates the hazard of AD and/or MCI development. Results The hazard of probable AD (HR = 3.50, [2.77 – 4.44], p < .0001) or MCI (HR = 2.13, [1.85–2.44], p < .0001) development was statistically significant for those with anxiety. This hazard was no longer statistically significant when specific anxiolytics were used. ɛ4 carriers experienced a statistically significant hazard of AD (HR = 1.92, [1.52–2.41], p < .001) and MCI (HR = 1.17, [1.04–1.32], p < .05) development. This effect was moderated by the use of anxiolytics. Discussion The results of this study suggest that anxiolytics may moderate the effect of anxiety on MCI and AD development, specifically indicating a neutralized hazard for those with ɛ4 carriers with anxiety. Copyright © 2016 John Wiley & Sons, Ltd.