Over the past several years, I have heard it promoted that anxiety and its symptoms be labeled as hidden elements of dementia. I don’t believe that they are hidden very well, for studies have shown that upwards to 70% of people living with dementia-related diseases will experience bouts of anxiety.

Consider the negative impact of being cognitively impaired; one can only wonder how anxiety would not become a symptom of dementia on a daily basis.

There are no doubts that the two go hand-in-hand.

I have found that, by keeping those living with dementia social, this, by itself, helps them retain a better quality of life. Their symptoms of anxiety are kept more at bay.

Recognizing the symptoms of anxiety is the first step in helping these people. Here are a few things we need to be on the alert for:

• Problems sleeping, or full-scale insomnia
• Cold or sweaty hands and/or feet
• Heart palpitations, tremors
• Excessive worrying
• Irrational fears
• An inability to sit still and calmly
• Dry mouth
• Muscle tension
• Numbness or tingling in hands or feet
• Panic attacks
• Upset stomach

We constantly need to become detectives while caring for those with dementia. If you start noticing signs of anxiety, I would start by inspecting their environment. Is there something or someone consistently around them when their anxiety rise up? Can you modify their environment to help them remain calm? How did you react?

Also, we need to listen closely to the frustrations of those living with dementia. The clues to helping them may be directly in front of you; you may just have to pay a little additional attention to what they’re trying to tell you. Calmly reassure these folks that you are going to try to address what is bothering them. Sometimes, just hearing those words will start toning down their symptoms. Respond to their emotions, not their behavior.

If you are noticing they’re building all this energy inside of them, constantly pacing or being very fidgety, work on finding an outlet so they can release some of it. Simply going for a walk with them may be extremely helpful.

Another tactic I would suggest, is placing something in their hands. There’s a saying I learned to live by, while caring for my dad; “Idle hands are the devil’s toys.” Have something available for them to attempt to work on, even if it’s something as simple as folding towels or sorting socks. Sometimes doing something repetitious can be very calming. Plus, it may actually help them feel that they still have purpose—which they do! The actual prevalence of their anxiety may be coming from their feeling they have little or no quality of life left. This would be disturbing for anybody!

If all of the above have failed, we need to address the situation with a qualified physician. Nobody should be left alone in the throes of an anxiety attack!

There are several different classes of anti-depressants that work well for anxiety. The patient’s doctor should always consider whether this medication is going to be used short or long-term. With many of these folks, as their dementia advances, they actually may no longer experience heavy anxiety.

It is extremely important that we know what type of dementia-related disease which with they have been diagnosed. Those living with Lewy body dementia can have adverse reactions to anti-depressants and neuroleptics medications, also known as antipsychotics. Please pay close attention if symptoms get worse or hallucinating begins.

It is unfortunate that anxiety compounds the misery for those who have already been diagnosed with dementia-related diseases, but this anxiety needs to be addressed, and right away. I have too many caregivers say to me “Well, they have a doctor’s appointment next month.” No. We do not wait weeks or even days. We pick up the phone and address this situation as soon as possible.

Even if you can possibly correct some of the onslaught of anxiety through caregiving tactics such as redirection and maintaining daily routines, the physician needs to be aware of what is happening to his or her patient.

Gary Joseph LeBlanc, CDCS
Director of Education
Dementia Spotlight Foundation