Anxiety in dementia: A critical review

Abstract

Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. 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. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer's Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed.

Anxiety disorders in older adults: a comprehensive review

“…[132] This comorbidity is partially due to the fact that not only cognitive decline/dementia common among the elderly, but also because there may be a specific relation with anxiety. Cognitive decline is an important consideration when defining anxiety disorders in this age group because it may affect presentation of symptoms, experience of symptoms, as well as the ability to communicate them.…”

Anxiety in old age and dementia - implications for clinical and research practice

“…Anxiety is also increasingly recognized (independently from depression) as a common symptom in older adults individuals living with various aetiologies of dementia, including Alzheimer's disease, vascular dementia, frontotemporal dementia, Lewy body disease, posterior cortical atrophy, dementia associated with Parkinson's disease, and in subjective and mild cognitive impairment, tending to result in poorer quality of life, problematic behaviours, limitations in activities of daily living, nighttime awakening and poorer neuropsychological performance [43,65,69,[77][78][79][80][81][82][83][84][85]. The relationship between anxiety and dementia is however both complex and controversial with overlap between the symptoms of anxiety and dementia and other behavioral and psychological problems such as agitation and depression [10,12,43,62,65,71,73,77,82,[86][87][88].…”

“…The relationship between anxiety and dementia is however both complex and controversial with overlap between the symptoms of anxiety and dementia and other behavioral and psychological problems such as agitation and depression [10,12,43,62,65,71,73,77,82,[86][87][88]. Although anxiety may increase the rate of conversion of MCI to Alzheimer's disease, be related to neuropathological status, associated with an increased risk of developing AD, and to influence cognitive impairment in MCI [19,47,62,68,73,74,87,89], directionality is complex [47,71,74,90].…”

“…Although anxiety may increase the rate of conversion of MCI to Alzheimer's disease, be related to neuropathological status, associated with an increased risk of developing AD, and to influence cognitive impairment in MCI [19,47,62,68,73,74,87,89], directionality is complex [47,71,74,90]. For example, in some individuals, perceived change in cognition or a diagnosis of MCI or SCI, can promote anxiety, whereas others are more susceptible to both anxiety and cognitive impairment [12,65,68,70,79,82]. Nevertheless, one can argue that treating anxiety in cognitive impairment or dementia may both remove a potential detrimental contributor to cognitive function and also improve the health and wellbeing of the individual living with these conditions.…”

“…Less well known are the effects of anxiety upon some of the more fundamental levels of information processing, as described in the following sections. Despite such evidence, anxiety can reportedly be largely undetected and untreated in older adults, especially in medical settings [63][64][65]; a possible consequence of diagnostic difficulty in older adults with multiple psychiatric, medical conditions [2], the attribution of symptoms to other factors [12], issues related to clinical practice [43], limitations to classification systems and the definition of anxiety in diseases such as dementia and the properties of assessment instruments [65]. Arguably therefore, improvement in health and wellbeing in older adulthood may be attained by raising awareness of the potential detrimental effects of anxiety in this age group and of the benefits of diagnosis and treatment [66,67].…”