Anxiety and dementia

Anxiety is an unpleasant feeling caused by the fear or thought that something bad is about to happen. It can also cause physical changes, such as higher blood pressure, heart rate and sweating. 

It’s common to feel anxious from time to time and for most people, these thoughts and feelings are not overwhelming and pass quickly once the source of anxiety is gone. 

However, for some people these feelings don’t go away. Over time, they prevent the person from doing the things they want or need to do. This is when anxiety becomes a mental health disorder.

Anxiety can affect people in different ways. There are several common types:

• generalised anxiety disorder (GAD)
• panic disorder
• irrational fears (phobia) – for example, being afraid of leaving the house.

Some people may also have obsessive thoughts that can make them feel anxious. Others may become anxious in social situations.

Anxiety is common in people who have dementia. It can also make thinking clearly and remembering things even more challenging.

Anxiety seems to be more common in people with dementia who still have good insight and awareness of their condition. It can be particularly common in people with vascular dementia or frontotemporal dementia (FTD) but less so in people with Alzheimer’s disease.

What causes anxiety in someone with dementia?

In dementia, the most common causes of anxiety include:

• worrying about difficult issues such as health, money problems or relationships
• damage to the parts of the brain involved in emotions
• stress, pain or exhaustion
• hallucinations (seeing or hearing things that aren’t real) and delusions (believing things that aren’t true)
• drinking too much caffeine or alcohol
• side effects of certain medicines
• stopping a medicine too quickly – particularly one prescribed for a mental health problem.

People may also be more likely to have anxiety if they have:

• a history of traumatic or upsetting events, such as violence, abuse or neglect
• had anxiety disorders in the past
• close relations who have had anxiety
• a personality more susceptible to negative feelings
• other long-term medical conditions or disabilities.

People who have had anxiety in the past are more likely to have it again.

In the early stage of dementia, anxiety is often related directly to worries about coping with the condition and what the future holds. In the later stage of dementia, anxiety may be related more to becoming confused or disoriented. For example, a person may worry that they need to go to work or pick up children from school. They may be cared for by someone they don’t recognise or feel comfortable with. 

The person may be discouraged from doing things they want to do for reasons they don’t fully understand, such as going out of the house, getting up during the night, or cooking without someone to help them. In such circumstances it can be natural for someone to become anxious.

Symptoms of anxiety

People with dementia who have anxiety may have a range of symptoms. They may feel tired, insecure, or irritable. They may struggle to think as well as usual.

Anxiety can also cause physical symptoms, such as a fast or irregular heartbeat (palpitations), shortness of breath, dizziness, nausea (feeling sick) or diarrhoea.

Anxiety can also cause changes in behaviour, such as becoming agitated or restless. A person may pace, fidget or harm themselves by repeatedly rubbing, picking or scratching their skin or pulling their hair. They may feel the need to hoard certain items in the home.

A person with dementia who is feeling anxious may feel scared to be left on their own and so follow a partner or family member around the home. This can be very difficult to cope with when it happens all the time.  

My mum has been suffering from anxiety of being alone for the past two years. Memory loss is an issue for sure, but the anxiety of being on her own is the major problem. Phone calls to friends and family are often repetitive sometimes calling up to 20 times a day.

Treatment for anxiety

Anxiety can be treated with a range of approaches, depending on the person’s needs. If a person with dementia has mild anxiety, it may help to listen to their worries and reassure them. 

Many things can cause anxiety or make it worse. Addressing these as much as possible can help a person to feel less anxious. For example:

• if they are worried that they will lose their balance and fall, doing things to stop this from happening can help to make them feel less anxious. This could include encouraging the person to do exercises to become physically stronger, installing grab rails or reducing any clutter in their environment.
• if pain is contributing to the person’s anxiety, they should have regular pain relief to help them feel more comfortable.
• if they are worried about being lonely or cut off from people, their friends and family members can help to make them feel included and remain socially active. 

Reducing anxiety can involve a range of people. This can include the person’s family and friends as well as professionals, such as GPs, clinical psychologists, psychotherapists, occupational therapists, physiotherapists and social workers.

It may help to adapt a person’s home so it feels calmer, safer and less stressful. It may also help to create a familiar routine for their everyday life that includes meaningful, stimulating and engaging activities.

People with more severe and persistent anxiety may benefit from psychological therapies such as cognitive behavioural therapy (CBT). There is also evidence that doing music therapy (with a qualified therapist) reduces agitation, which can be a symptom of anxiety. Some people may also be prescribed medication to treat their anxiety.

Tips for supporting a person with dementia who has anxiety

Always involve the person with any decisions and choices to make, whilst encouraging them to:

Talk about their worries or fears

• Help the person find the right time and space to share their thoughts.
• If something very upsetting or traumatic has happened recently or in the past, the person may find it helpful to talk about them. 
• If these conversations are too difficult or sensitive, or the person doesn’t feel comfortable talking to someone they know, ask a professional counsellor or therapist for help first.

Continue with treatment

• Keep taking anti-anxiety medication or using talking therapies offered to them, even if improvement is slow at first.

Stay active

• Regular physical activity can reduce feelings of anxiety and also help with sleep problems. Where possible, support and encourage them to regularly go outdoors and spend time in natural environments.
• Take part in group activities, such as dancing or singing.

Eat and drink well

• Eat a wide range of healthy foods.
• Drink plenty of fluids to avoid dehydration.
• Drink alcohol and caffeinated drinks moderately, if at all.

Some people with anxiety may also want to try complementary and alternative therapies. This could include aromatherapy, acupuncture, massage therapy and herbal medicines (for example Ginkgo biloba and CBD oil). 

There is not much evidence that these therapies are effective for treating anxiety in people with dementia but many people choose to try them anyway. If you have any concerns about the safety of a particular therapy, you should speak to your doctor first.