Anxiety and dementia
It is common for people with dementia to have anxiety. It can make symptoms of dementia worse – particularly symptoms that affect a person’s attention, planning, organising and decision-making.
Apathy, depression and anxiety
Everyone feels anxious from time to time. It is caused by the fear or thought that something bad is about to happen. When a person feels anxious they may also have physical changes, such as higher blood pressure, heart rate and sweating. For most people feeling anxious will pass quickly when they no longer sense any danger. However, a person with anxiety can find it very difficult to stop thinking and feeling that something bad is about to happen.
Anxiety is the main symptom of a number of mental health conditions. These include generalised anxiety disorder (GAD), panic attacks and phobias. Some people may also have obsessive thoughts that can make them feel anxious. Anxiety can have a serious impact on a person’s everyday life.
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 or frontotemporal dementia (FTD). It is less common in people with Alzheimer’s disease.
Causes of anxiety
Some causes of anxiety are similar to causes of depression. The causes of anxiety in a person who has dementia are often similar to the causes in people who don’t have dementia. These include:
- having a history of traumatic or upsetting events
- worrying about difficult issues such as health or money problems or relationships
- damage to the parts of the brain that regulate emotion
- having a family history of anxiety.
People who have had anxiety in the past are more likely to have it again. However people in the early stages of dementia may have anxiety that is linked directly to their worries about their memory and the future. People with vascular dementia often have better insight and awareness of their condition than people with Alzheimer’s disease. This may explain why it’s more common for people with vascular dementia to have anxiety.
People who live in a care home may have anxiety that is linked to a lack of individual care and needs that are overlooked. For example, they may have no one to talk to regularly or daytime activities to keep them active. As their condition progresses, people with dementia become more disorientated, forgetful and less able to think things through. For some people this struggle to make sense of the world can cause anxiety.
However, there are things that carers and people around them can do to support a person with dementia to feel less anxious as their condition progresses. For more information see our pages 'The later stages of dementia', and 'Understanding and supporting a person with dementia'.
Symptoms of anxiety
People with dementia who have anxiety may have a range of psychological symptoms. As well as feeling anxious they may feel tired, uneasy, irritable, and struggle to concentrate. They may also have physical symptoms – fast or irregular heartbeats (palpitations), shortness of breath, dizziness, nausea or diarrhoea.
A person with dementia who has anxiety may also have changes in their behaviour, such as being agitated or hoarding. They may constantly ask for reassurance and not want to be left alone. Or they may closely follow a carer or family member around. They may also be restless and pace or fidget.
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 make a person 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.
It may help to adapt a person’s home so it feels calmer, safer and less stressful. For more information see our page 'Using equipment and making adaptations at home'. It may also help to create a familiar routine for their everyday life that includes meaningful, stimulating and engaging activities.
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 becoming 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, psychotherapists, occupational therapists, physiotherapists and social workers.
People with more severe and persistent anxiety may benefit from psychological therapies such as cognitive behavioural therapy (CBT) (see the section 'Talking therapies'). 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.
How to support a person with dementia who has anxiety
Encourage them to:
- talk about their worries or fears
- If something very upsetting or traumatic has happened recently or in the past, the person may find it helpful to talk about their feelings – however, if it was severe emotional trauma, ask a professional counsellor or psychotherapist for help first (see the section ‘Talking therapies’).
- If they are not comfortable discussing sensitive issues with someone they know, it may help if they instead talk to a professional counsellor or therapist.
- continue with treatment
- Encourage them to keep taking anti-anxiety medication or doing a course of therapy, even if they think improvement is slow at first.
- stay active
- Doing physical activity can reduce feelings of anxiety and sleeping problems.
- Doing group activities can also help to reduce anxiety (such as dancing or singing).
- If they can, support and encourage them to regularly go outdoors and spend time in natural environments (they may need emotional support to do this).
- maintain a healthy diet
- An unhealthy diet can contribute to feelings of anxiety.
- Support them to eat a wide range of healthy foods and not to drink too much alcohol or caffeinated drinks
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). If a person wants to try these they should speak to their doctor first.
Some alternative therapies might benefit people with dementia. They work by treating the conditions related to dementia, such as sleep problems or agitation.