Anxiety: a hidden element in dementia

Abstract

SummaryAnxiety has reported prevalence rates between 38 and 72% among people with dementia. It has a negative impact on cognitive impairment and is associated with agitation and poor quality of life. The presence of excessive anxiety can be difficult to establish in people with dementia, especially when expressive or receptive speech is impaired. Unfortunately, there is a lack of research on the treatment of anxiety in dementia, and also on the wider issue of the management of anxiety disorders in old age. We explore the prevalence, presentation and diagnosis of anxiety in dementia and discuss the therapeutic options available.

Norwegian version of the rating anxiety in dementia scale (RAID-N): a validity and reliability study

“…Certain mental health and physical conditions such as depression, schizophrenia, and cardiovascular, respiratory, and endocrine diseases are associated with anxiety and anxiety symptoms among people with dementia (Badrakalimuthu & Tarbuck, 2012;Johansson & Gustafson, 1996). Poorly defined stimuli such as shadows and noises combined with vision and hearing deficits in older people with dementia may be misinterpreted and cause anxiety.…”

“…A large Australian prospective longitudinal study conducted a multidisciplinary intervention program comprised of case review, medication review, and staff education and reported a 13% decline in antipsychotic prescriptions and a 21% decrease in benzodiazepine prescriptions at 6-month follow-up among the residents of aged care facilities (Westbury et al, 2018). Use of cholinesterase inhibitors, anxiolytics, and antidepressants combined with psychosocial interventions may be evaluated, especially for severe anxiety symptoms and comorbidity with depression (Badrakalimuthu & Tarbuck, 2012;Gustafson, 1995;Shankar & Orrell, 2000).…”

Melatonin and Major Neurocognitive Disorders: Beyond the Management of Sleep and Circadian Rhythm Dysfunction

“…In its management, counselling and psychological treatments are generally considered before application of drugs. Pharmacological management of anxiety in dementia patients utilises drugs such as citalopram, sertraline and fluoxetine, which are proven to have a safe profile, and are evidently effective in reducing anxiety; in addition, citaprolam appears to improve behavioural symptoms (Badrakalimuthu and Tarbuck, 2012). Benefits that may be derivable from the use of drugs such as clomipramine or imipramine might be offset by their association with cognitive decline.…”

What is the therapeutic value of antidepressants in dementia? A narrative review

“…Despite anxiety being common in dementia (Badrakalimuthu and Tarbuck, 2012) and previous recommendations to use antidepressants in its treatment (Sink et al, 2005), few RCTs have investigated the effects of antidepressants on anxiety in dementia. In four trials, treatment had no significant effect on anxiety score over placebo (Lebert et al, 2004;Teranishi et al, 2013;Nyth et al, 1992;Nyth and Gottfries, 1990).…”