dementia anxiety treatment

Dementia anxiety treatment often begins with something surprisingly simple: working out what may be making the person anxious.

People living with dementia can experience anxiety, fear, restlessness and agitation. Sometimes these feelings are related directly to changes in the brain. In other cases, pain, illness, medication side effects, tiredness, hunger, unfamiliar surroundings or difficulty understanding what is happening may be contributing.

For this reason, the best response is usually not simply to try to stop the anxious behavior. Instead, look for the cause, reduce distress and help the person feel safe.

What Does Anxiety Look Like in Dementia?

Anxiety may not always look like someone saying, “I’m worried.”

As dementia progresses, a person may find it increasingly difficult to explain what they are feeling.

Signs of anxiety can include:

• Restlessness
• Pacing or wandering
• Repeated questions
• Fearfulness
• Irritability
• Difficulty relaxing
• Clinging to a caregiver
• Difficulty sleeping
• Becoming distressed when left alone
• Worrying about events that are not happening
• Becoming upset in unfamiliar surroundings
• Physical tension

Anxiety and agitation often overlap, but they are not necessarily the same thing.

The Alzheimer’s Association explains that people with Alzheimer’s may become anxious or agitated when they have difficulty understanding new information, changes in their surroundings or what is happening around them.

Dementia Anxiety Treatment Should Start With the Cause

Before treating anxiety as purely an emotional or behavioral problem, consider whether something else may be wrong.

The National Institute on Aging identifies several problems that can contribute to agitation or distress in someone with Alzheimer’s disease.

These can include:

• Pain
• Constipation
• Illness or infection
• Medication side effects or interactions
• Lack of sleep
• Hunger or thirst
• Too much noise or activity
• Changes in familiar surroundings
• Changes in caregivers
• Loneliness
• Fear or confusion

A sudden change in behavior deserves particular attention.

If someone who is normally calm suddenly becomes extremely anxious, agitated or confused, contact their health care professional so that possible medical causes can be investigated.

10 Dementia Anxiety Treatment Strategies

There is no single dementia anxiety treatment that works for everyone.

However, the following approaches can help caregivers identify triggers, reduce distress and create a greater sense of security.

1. Check for Pain or Physical Discomfort

One of the first questions should be: Could something be hurting?

A person with dementia may not be able to explain that they have a headache, toothache, constipation, an infection, uncomfortable clothing or another source of discomfort.

Look for changes such as:

• Grimacing
• Guarding part of the body
• Changes in walking
• Reduced appetite
• Difficulty sleeping
• Sudden agitation
• Repeatedly touching one area of the body

Our guide to dementia and pain explains other signs that caregivers can watch for.

2. Offer Calm Reassurance

Trying to reason someone out of their fear may not always work.

If a person believes something frightening is happening, arguing that they are wrong can sometimes increase their distress.

Instead:

• Speak slowly and calmly
• Stay at eye level
• Use short, simple sentences
• Listen to what is upsetting them
• Acknowledge their feelings
• Reassure them that they are safe
• Stay with them until they become calmer when possible

The Alzheimer’s Association recommends reassurance and calm, positive communication rather than arguing or criticizing.

3. Create a Calm Environment

The environment can have a major effect on someone who has difficulty processing information.

Too many conversations, a loud television, glare, clutter or unfamiliar people can become overwhelming.

Try:

• Turning down the television or radio
• Reducing unnecessary background noise
• Removing clutter
• Providing comfortable lighting
• Moving to a quieter room
• Keeping familiar belongings nearby
• Avoiding large groups when they cause distress

These simple changes may reduce the amount of information the person is trying to process at once.

4. Keep a Predictable Daily Routine

Dementia gradually makes it more difficult to understand and adapt to change.

A predictable routine can therefore be reassuring.

Where practical, try to keep:

• Meals at approximately the same times
• Regular waking and bedtime routines
• Familiar caregivers
• Regular activities
• Consistent bathing and dressing routines

This does not mean every day needs to be rigidly scheduled. The objective is simply to make daily life more predictable.

5. Look for Anxiety Triggers

Patterns can provide valuable clues.

If anxiety frequently occurs at a particular time or during a particular activity, ask what might be triggering it.

For example:

• Does anxiety begin when a caregiver leaves?
• Does bathing cause distress?
• Does it worsen late in the afternoon?
• Does a noisy room trigger agitation?
• Does the person become anxious when hungry?
• Are they frightened by a reflection or shadow?
• Does anxiety occur around unfamiliar people?

Keeping a simple diary of what happened immediately before an anxious episode can help identify patterns.

Someone who appears anxious may also be thirsty, hungry, tired, uncomfortable or in need of the bathroom.

6. Encourage Appropriate Physical Activity

Movement can provide an outlet for restlessness and may improve mood and sleep.

Activity does not need to involve a gym.

Depending on the person’s mobility and health, options may include:

• Walking
• Gardening
• Dancing
• Gentle stretching
• Simple household activities
• Chair exercises

The Alzheimer’s Association specifically suggests walking, gardening or dancing as possible ways to reduce agitation and provide an outlet for energy.

See our guide to exercise and dementia for more ideas.

7. Use Music and Familiar Activities

Familiar and enjoyable activities can redirect attention away from anxiety.

These might include:

• Listening to favorite music
• Looking through family photographs
• Gardening
• Folding laundry
• Drawing or painting
• Watching a familiar television program
• Reading together
• Doing a simple household task

Music can be particularly useful when it is familiar and meaningful to the person.

The aim is not necessarily to keep someone busy. It is to provide something familiar, manageable and pleasant that can help shift attention away from distress.

8. Maintain Social Connection

Loneliness and isolation can contribute to distress.

Some people benefit from:

• Regular family visits
• Small social groups
• Dementia-friendly community activities
• Adult day programs
• Faith or community groups
• Support groups

The amount of social interaction should suit the individual. A busy group may comfort one person and overwhelm another.

Quality and familiarity are often more important than the number of people involved.

9. Consider Psychological Therapy When Appropriate

Some people with mild or moderate dementia may still be able to participate in psychological therapies designed to help with anxiety.

One option is cognitive behavioral therapy (CBT), particularly when it is adapted for cognitive impairment and involves caregivers when appropriate.

A recent systematic review indexed by the U.S. National Library of Medicine’s PubMed database found that CBT was associated with reduced anxiety in people with dementia, although researchers noted that dementia-specific adaptations and caregiver involvement may be important.

CBT is not suitable for everyone, particularly when dementia has become advanced, so discuss psychological treatment options with the person’s health care professional.

10. Discuss Medication With a Doctor When Necessary

Medication may sometimes form part of a dementia anxiety treatment plan, particularly when symptoms are severe, persistent or causing significant distress.

However, medication choice requires particular care in older adults with dementia.

The National Institute on Aging recommends trying appropriate non-drug approaches before medications for many behavioral symptoms of Alzheimer’s disease.

What Medications Are Used for Anxiety in Dementia?

There is no single medication that is right for every person with dementia and anxiety.

A physician may sometimes consider antidepressants or other medications depending on:

• The person’s symptoms
• Whether depression is also present
• Other medical conditions
• Current medications
• Risk of falls
• Potential drug interactions
• The severity and duration of the symptoms

Benzodiazepines Require Particular Caution

Benzodiazepine anti-anxiety medications can sometimes reduce severe anxiety quickly, but they can also be problematic in older adults.

The National Institute on Aging warns that these medications can cause:

• Sleepiness
• Dizziness
• Falls
• Confusion

For this reason, they may be used only for short periods, if at all, depending on the individual.

Antipsychotics Are Not Routine Anxiety Treatment

Antipsychotic medications should not be viewed as a routine treatment for anxiety in dementia.

They may sometimes be considered for severe agitation, aggression, hallucinations or psychosis when symptoms create significant distress or safety concerns and other approaches have not worked.

These medications can carry serious risks for older adults with dementia.

The Alzheimer’s Association provides current information about medications used for behavioral symptoms of Alzheimer’s disease and emphasizes careful, individualized medical decision-making.

Never start, stop or change an anxiety, antidepressant or antipsychotic medication without speaking with the person’s prescribing health care professional.

What About Pet Therapy?

Animals can provide companionship, familiarity and enjoyable interaction for some people with dementia.

This may involve a family pet, trained therapy animal or supervised animal-assisted activity.

However, response varies considerably.

Someone who has always loved animals may find the experience calming, while a person who is frightened of animals may become more anxious.

As with other activities, the individual’s preferences should guide the decision.

When Should Anxiety Be Medically Assessed?

Contact the person’s doctor when anxiety:

• Appears suddenly
• Becomes significantly worse
• Interferes with eating or drinking
• Causes severe sleep disruption
• Is associated with hallucinations or delusions
• Occurs after a medication change
• Is accompanied by pain, fever or signs of illness
• Creates a risk of harm to the person or others
• Cannot be managed with usual reassurance and support

A sudden behavioral change can sometimes indicate pain, infection, medication side effects or another medical problem rather than simply progression of dementia.

Dementia Anxiety Treatment: Key Takeaway

The most effective dementia anxiety treatment depends on why the person is anxious.

Start by looking for pain, illness, medication effects, hunger, thirst, fatigue, fear or environmental triggers.

Calm communication, predictable routines, reduced noise, physical activity, familiar music and meaningful activities can all help some people feel safer and less distressed.

When anxiety remains severe or persistent, talk with the person’s health care professional about psychological therapies and whether medication is appropriate.

Most importantly, try to see anxious behavior as communication. The person may not be able to explain exactly what is wrong, but their behavior may be telling you that they are frightened, uncomfortable or overwhelmed.