Alzheimer’s Disease and Anxiety

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

Anxiety is a feeling of uneasiness, nervousness, or fear. Everyone feels anxious sometimes, but feeling that way often or all the time can affect your health.

As many as 3 in 4 people with Alzheimer’s disease may have some level of anxiety. It’s often one reason behind challenging behaviors like wandering and aggression.

People with Alzheimer’s disease may have trouble saying how they feel. You may not know when your loved one is worrying or feeling anxious. You might instead notice other signs, such as:

  • Avoiding social situations
  • Irritability
  • Agitation
  • Restless behaviors like wandering, doing the same thing over and over, or not staying still
  • Muscle tension, even if they’re not aware of feeling anxious
  • Not sleeping well

Emotional Triggers

Some medications can treat anxiety, but they often don’t work well for older people and people with Alzheimer’s disease. Instead, it can be helpful to figure out what might be causing your loved one’s anxiety and try to address it.

Think carefully about what happened right before they seemed anxious and look for possible reasons:

Could they be uncomfortable?

  • Could they feel sick?
  • Could they feel hungry, thirsty, hot, cold, or tired?
  • Could they need a bathroom? Are their clothes uncomfortable?
  • Could they be in pain?

Could they be confused?

  • Could they believe something is happening that isn’t? For example, do they accuse you of things that are not true?
  • Could they be seeing or hearing things that are not there?
  • Are they not able to understand what is being said or what is happening?
  • Do they forget where things are around the home?

Could they have too much or too little activity?

  • Are they bored?
  • Are they lonely?
  • Are they overwhelmed because they’ve been asked to do too much?

Could they be upset because of a recent change in routine?

  • Have they recently moved to a new place?
  • Have they moved in with someone new, or has someone new moved in with them?
  • Has there been a change in their daily routine?

Could their surroundings be upsetting them?

  • Are they in an unfamiliar place or one that they don’t recognize?
  • Are they somewhere noisy or busy?
  • Have they been around many people whom they don’t know?
  • Could they feel that people are treating them differently, or like a child?
  • Could they be responding to your emotions?
  • Could caffeine, alcohol, or other drugs be part of the problem?

Did they have anxiety before they had Alzheimer’s disease?

  • What sorts of things caused anxiety before they had Alzheimer’s disease?
  • Could they be worrying over the same things now?

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Care at Home

Once you think you know what may be behind the anxiety, make a plan to help make it better. If the first thing you try doesn’t work, try something else. You may need to try several things, and something may work one day and not the next. If nothing seems to help, talk with a doctor or counselor.

You might:

  • Take them for a walk, offer them a snack, or ask them to help you do something.
  • Play their favorite music.
  • Reassure them that they’re safe and that you’re here to help.
  • If they let you touch them, hold their hand, give them a hug, or give them a massage.
  • Help them get gentle exercise, such as going for a walk or helping in the garden.
  • If they had anxiety in the past, help them do things that helped before if possible. Examples could include taking deep breaths or sitting in a relaxing place.

If they’re uncomfortable:

  • Offer food and drink if you think they might be hungry or thirsty.
  • Offer a sweater or a blanket if they seem cold.
  • Turn on a fan or move them to a cooler room if they seem warm.
  • See if they need a bathroom, or if they need a change of clothes because of incontinence.

If they’re confused:

  • Make sure hearing aids are working and they're wearing glasses if they need them.
  • Put labels on items and rooms around the house that they might have trouble finding.
  • If they repeat questions, give them a calm answer each time they ask. Don’t get angry or tell them they’re repeating things.
  • Speak in short, simple sentences, and give them time to respond.

If the anxiety is caused by their surroundings:

  • Remove distractions when possible. Turn off the TV or stay away from busy places.
  • Stick to a daily routine as much as possible.
  • Use brighter indoor lighting.
  • Limit or avoid caffeine and alcohol.

If there’s too much activity:

  • Give them simple activities.
  • Give them time to rest after activities.
  • Don’t rush or correct them.
  • Speak slowly and calmly.
  • Stay away from busy, crowded, or strange places.

If they’re bored:

  • People with Alzheimer’s disease often find it hard to start activities on their own. It helps to plan things for them to do.
  • When planning activities, think about things they liked to do in the past.

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Anxiety and Aggression

Sometimes people with Alzheimer’s show anxiety by becoming agitated. This can sometimes turn into aggressive behavior like hitting, pushing, or yelling. If your loved one tends to become agitated or aggressive, you can do some things to keep everyone safe:

  • Keep dangerous things like guns, knives, glass, and sharp or heavy objects out of the house or locked away.
  • If you can’t calm them down, give them space.
  • Consider asking someone nearby, like a neighbor, to be ready to help if needed.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Neil Lava, MD on August 04, 2018

Sources

SOURCES:

Advances in Psychiatric Treatment: “Anxiety: a hiding element in dementia.”

Alzheimer’s Society: “Apathy, depression and anxiety.”

Journal of Geriatric Psychiatry and Neurology: “Anxiety and Alzheimer’s Disease.”

Caring.com: “Activities for Alzheimer’s and Dementia Patients.”

Clinical Psychology Review: “Anxiety in dementia: A critical review.”

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