Treating Dementia and Anxiety
Randi Fredricks, Ph.D.
Until recently, little attention has been paid to anxiety treatment and symptoms in dementia. Anxiety is common in this population, and associated with poor outcome and quality of life. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information.
While most of us know the ways that dementia can disrupt memory, communication and thinking, dementia-causing diseases like Alzheimer’s also cause a number of mental health symptoms. According to research, as much as 70 percent of people with dementia also experience an anxiety disorder over the course of their disease.
There are tests designed specifically to assess anxiety in aging populations to determine anxiety treatment. According to two of these tests, anxiety may be higher in vascular dementia than in seen in patient with Alzheimer’s Disease.
Anxiety and Advanced Stages of Dementia
Additional research shows that anxiety may actually decreases in the severe stages of dementia. When anxiety is present with dementia, it is associated with poor quality of life and behavioral disturbances, even after controlling for depression.
In anxiety treatment studies, the rate of anxiety disorders and symptoms in dementia varies dramatically from study to study, suggesting that there is a lack of consensus about how to define and conceptualize anxiety in this population. Several issues complicate this problem, including the distinction between symptoms of anxiety and symptoms of dementia, the overlap between anxiety, depression, and agitation, and what constitutes the best source of information (e.g., patient, caregiver).
In older adults without dementia, anxiety has been associated with functional limitations, poorer physical health and reduced activities. Additionally, anxiety symptoms have been associated with nursing home placement prospectively, even after controlling for initial cognitive functioning.
The Alzheimer’s Association advises therapist doing anxiety treatment to help mitigate anxiety symptoms by trying to understand its underlying cause. Once this is identified, the caretaker should then modify the patient’s environment to remedy the situation.
Dementia patients often experience anxiety after a change in living arrangements, changes in routine that include everything from travel to the presence of house guests. Efforts to simplify routines as well as the environment are often met with a reduction in anxiety.
Treatment of Anxiety in Dementia Patients
There are treatment options for people suffering from anxiety and dementia. Treatment options are available to manage the anxiety, which may bring much-needed relief to patients and caregivers alike. A class of antidepressants referred to as selective serotonin reuptake inhibitors, or SSRIs, are often used to treat anxiety in older dementia patients who require it for long-term use.
These medications can include Lexapro, Prozak, Wellbutrin, and Zoloft. While these drugs are frequently used to treat both anxiety and depression in people with dementia, they have not been specifically approved by the U.S. Food and Drug Administration to treat behavioral or psychiatric symptoms related to dementia, which means that the exact dosages are not known, nor are the potential side effects or long-term effects. In addition, some antidepressants such as Paxil, Elavil, and others may worsen the cholinergic imbalance in the brain and worsen memory, thinking or the effectiveness of memory medications.
Research findings indicate that antidepressant use is significantly associated with an increased risk of developing dementia. Therefore, physicians need to carefully prescribe antidepressants, especially in elder patients. Additionally, treatment should be stopped if any symptoms related to dementia are to be noticed. Better yet, alternative treatments to antidepressants should be considered.
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About the Author
Randi Fredricks, Ph.D. is a practicing therapist, researcher and author specializing in the treatment of anxiety, depression, addiction, eating disorders, and related disorders. Dr. Fredricks is a best-selling author of numerous books on complementary and alternative treatments for mental health including Complementary and Alternative Treatments for Anxiety. For more information on Dr. Fredricks work, visit her practice website www.DrRandiFredricks.com.