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Dementia can be a scary experience. Managing anxiety can reduce agitation and acting out, and reduce the burden of the disease on the patients and caregivers alike.

Anxiety is very common in dementia, but treatments for anxiety can be hard to come by. Family and non-professional caregivers can help their loved ones deal with anxiety with some knowledge of the condition and how to relieve it.

First, here are some basics about anxiety in dementia.

  • Anxiety disorders are about twice as common among people who have dementia as they are in people who do not have dementia.
  • Any kind of dementia can provoke anxiety, but persistent symptoms of anxiety are most common in Parkinson's disease and vascular dementia. Anxiety is less common in Alzheimer's disease.
  • There isn't any one medication that is always effective in treating anxiety, although antidepressants (both newer SSRI antidepressants and older-style tricyclic antidepressants) sometimes help. It is essential for the doctor in charge of the case to choose the medication because of interactions and side effects.
  • Likewise, there isn't any single psychological intervention that always helps to relieve anxiety, but a mixture of methods is usually optimal.
No medical intervention for anxiety in dementia stops the progression of the disease. It is unusual for treatment for anxiety to result in the patient's reporting improved quality of life, although that may be due to the nature of dementia. Treatments for anxiety reduced agitation, and make care of the patient easier. Helping the patient actually feel better takes a different set of skills. Here is what you can do.

What do you do first when you are confronted with an anxious dementia patient?

The first step in dealing anxiety in people who have dementia is easy to do but hard to remember: Back off. Don't do anything that makes the anxiety worse. "Backing off" doesn't mean leaving the patient alone. That is usually not helpful. But don't rush to offer hugs or hold hands or coo soft words of reassurance, at least not before the patient has an opportunity to express what is troubling them.

Create a calming environment

Noise, odors, scratchy clothing or bed covers, and loud conversations outside all can contribute to anxiety. As much as you can, make the room quiet when your find an upset, anxious resident. If the anxiety isn't severe, offer a pleasant activity to help distract from whatever has triggered anxiety. Don't offer so many choices, however, that you cause more anxiety. Limit the choices to two options.

What to say to someone with dementia who is having anxiety issues

Start by asking for permission to help: "May I help you?" Deliver your offer of assistance in a tone of voice that conveys concern. If the problem is a fight or some other kind of distressing incident outside the patient's room, apologize. Reassure the patient that the situation is now under control. Take a moment to allow the patient to respond. Assure them that you will stay until they feel better.

Then use some combination of the following steps as they fit the situation:

  • Let the patient talk. Listen to their frustration. Let them express their concern without pronouncing judgment over its validity if it sounds delusional or it is the result of a hallucination. Remember, the source of anxiety is real to them even if it isn't real to you.
  • Repeat assurances. You may have to tell the patient things are alright more than once. You may have to reassure the patient you will stay until they are better (and then stay) more than once.
  • Distract the patient from the source of anxiety. That distraction could be reminiscing about happy times, playing music, a board game, a 30-minute television program, or a quick trip to a safe location outdoors. Or take a brief car ride.Give the person something to do.
  • Do your best to keep the room in good repair. Leaks and drafts are common triggers for anxiety attacks.
  • Check yourself. Don't raise your voice. Don't show offense. Don't argue, corner, belittle, restrain, criticize, or ignore. Avoid sharing your assessments of the situation with coworkers or other family members until not only is the patient out of earshot, but until a time the patient is not aware you are having the discussion.

Bring repeated incidents of anxiety to the doctor's attention. The prescription may be for a psychological intervention, not for a drug.

What about therapy animals? A therapy dog or a therapy cat isn't automatically a good choice for relieving anxiety in dementia. Not everyone has had good experiences with pets. It's important to ask an informant, usually a family member or a close friend, about the patient's history with animals before bringing a therapy animal into the room. Allergies are also a consideration. Therapy animals on the floor, in common rooms, or in a shared garden, can actually increase anxiety in nursing homes. Patients may compete for the attention of the animal, and some patients are invariably left out of the visit with the therapy animal. It may be best to have a private session with the animal or no session at all. Every therapy dog or cat session should be supervised.

  • Goodarzi Z, Mele B, Guo S, Hanson H, Jette N, Patten S, Pringsheim T, Holroyd-Leduc J. Guidelines for dementia or Parkinson's disease with depression or anxiety: a systematic review. BMC Neurol. 2016 Nov 25.16(1):244. Review. PMID: 27887589.
  • Ismail Z, Gatchel J, Bateman DR, Barcelos-Ferreira R, Chantillon M, Jaeger J, Donovan NJ, Mortby ME. Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria.Int Psychogeriatr. 2018 Feb.30(2):185-196. doi: 10.1017/S1041610217001880. Epub 2017 Sep 13. Review. PMID: 28899446.
  • Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2014 Jan 22
  • .1):CD009125. doi: 10.1002/14651858.CD009125.pub2. Review. PMID: 24449085.
  • Photo courtesy of SteadyHealth

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