How to Recognize Signs of Anxiety in Alzheimer's Disease

Although memory loss and impaired thinking are its hallmarks, Alzheimer's disease also causes other problems, including anxiety. This feeling of uneasiness, fear, and apprehension occurs in many who have Alzheimer's, particularly during the early and middle stages of the disease.

Man outside with his hands on his head in distress
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Anxiety can increase distress for both those with the disease and their caregivers, but a number of pharmaceutical and behavioral strategies can help.

Recognizing Anxiety

Anxiety among those with Alzheimer's can be hard to recognize. Typical anxiety symptoms include excessive worry, tenseness, sweating, and a racing heartbeat. But anxiety in Alzheimer's can take other forms. Social withdrawal or decreased engagement in once-pleasurable activities—typically associated with depression—can also reflect anxiety. Alzheimer's anxiety often occurs together with depression and irritability.

Angry outbursts or following family members or caregivers from room to room (also known as shadowing) may occur because the individual no longer fully understands what to do or expect—or what's expected of him. You may hear someone with dementia crying or calling out repeatedly, and this can also be a sign of anxiety.

Behavioral Approaches

Once you note signs of anxiety, the Alzheimer's Association recommends trying to identify the cause. It may be a reaction to the Alzheimer's diagnosis or to the uncertainty of the future. Anxiety may involve fear of being alone or particular stresses, such as financial worries. Change is often a problem, such as a new caregiver, hospitalization, or travel. Parts of the daily routine, such as bathing or changing clothes, may induce anxiety.

Once you identify the sources, you can try to minimize their impact. It's best to start with non-drug, behavioral management. Drugs have side effects, and since most people with Alzheimer's are older, they're likely to be taking other medications, increasing the risk for drug interactions.

Sometimes distraction or redirecting the individual's attention is enough. Avoid becoming confrontational or overexcited. Simplifying the environment and daily routine can also help. Other useful strategies include allowing for rest and quiet between potentially stressful activities and making sure there's adequate light in the evening to reduce the potential for confusion and sundowning. Structured activities—familiar music, pets, walking, or light exercise—can also be calming.

Finally, experts advise caring for the caregivers—through support, respite care, and for those who are still caring for someone at home, through the additional use of home care aides or adult daycare.

Pharmaceutical (Medication) Treatment

The FDA hasn't approved any drug specifically for Alzheimer's anxiety. General anti-anxiety medications—such as Ativan (lorazepam)—are short-term solutions. However, they can cause physical unsteadiness and heighten confusion and memory impairment. If the person has anxiety and depression, it may help to use antidepressants, for example, selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Zoloft (sertraline). Desyrel (trazodone), which affects serotonin but is not an SSRI, may also be beneficial.

Alzheimer's disease disrupts neurotransmitters, which are the chemicals that carry messages between brain cells. For behavioral symptoms, the cholinergic system, which is involved in emotions and mood (including anxiety), is especially important.

Various drugs known as cholinesterase inhibitors, which counter the loss of cholinergic neurotransmitters, help slow the cognitive impact of Alzheimer's disease. A 2007 review in The Consultant Pharmacist—summarizing research on various "cognitive enhancers" for Alzheimer's behavioral symptoms—emphasized that cholinesterase inhibitors can benefit behavioral as well as cognitive problems.

Study author Lisa J. Miller reported that Aricept (donepezil), the most studied of these medications, shows "the greatest positive effects." But she noted that benefits were "harder to demonstrate for mild-to-moderate" symptoms. In addition, the effects of specific medications can vary from person to person.

Among alternative therapies, Ginkgo biloba, a tree long valued in China for its medicinal properties, has shown some promise. Some European studies suggest that ginkgo may offer both cognitive and behavioral benefits, including alleviation of anxiety.

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