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Question: My sister who is afflicted with Alzheimers is often extremely anxious and I was wondering if this is common? She is 64 years old and in the mid-stage of the disease? Would you know of a possible cause for the anxiety, and, if so, a remedy? I often experience mild anxity and take Xanax which seems to calm my nerves. Any input would be greatly appreciated.

Answer by: Melinda Stanley, Ph.D., is Professor of Psychiatry and Behavioral Sciences and Head of the Division of Psychology in the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine.

Anxiety symptoms are common in patients with Alzheimer’s disease and other forms of dementia. On average, 36% of people with dementia have significant anxiety, and it seems that anxiety occurs more often for patients in the mild and moderate stages of dementia.

When anxiety occurs for people with dementia, it can be associated with poorer quality of life, more limitations in functioning, and decreased activity. So, it is good that you have noticed this type of symptom in your sister so that the two of you can work with your providers and with each other to reduce anxiety.

Many things can cause anxiety in people with and without dementia. The realization that memory is not as good as it once was can create anxiety as people wonder what is wrong with them and what the future holds. Sometimes, simple changes in routine make people with dementia anxious because they are unable to remember what is supposed to happen next. In order to decide how best to help your sister, it will be important to try and determine what kinds of things create anxiety for her. This can be a challenging task for people with dementia because they may have difficulty understanding and expressing their anxiety. So, it might be helpful for you to begin to pay closer attention to her anxiety for a few days to see if you can find common patterns. Keeping a simple chart can help. For example, does she seem to get more anxious, for example, when she is alone or when someone is leaving, when there are changes in her routine, or when she is confused about something? Does she have specific fears of things (e.g., falling) or does she mention the same situations over and over that are causing her worry or concern (e.g., finances, family members, her own health, etc.)?

Some doctors prescribe medication for patients with anxiety and dementia. However, the Xanax that you take may not be the best choice for your sister. Xanax is one of the medications known as benzodiazepines – these medications can reduce anxiety, but they can also create more memory problems and increase the risk of falls since they slow reaction times and disrupt balance. Some kinds of antidepressant medications, though, may help to reduce anxiety for some patients.

Non-medication treatments can also be useful – and often are preferred by patients and their loved ones. In our work with patients who have both anxiety and dementia, we have found relaxation strategies to be useful. Sometimes anxiety makes people breathe too quickly and shallowly. People with dementia can learn to reduce their anxiety by breathing more slowly and more deeply. Sometimes simple statements written on cards can also help to reduce anxiety. For example, if a person with dementia repeatedly worries about finances, a statement such as, “I have enough money,” may be enough to reduce anxiety when those fears arise. Staying busy with rewarding activities also can help to distract people from their worries and make them feel more satisfied with their lives. Look for activities that your sister used to enjoy, although she may need to do them in a different way now than she was able to do before (e.g., if she enjoyed reading novels, she may now enjoy magazines with short stories and/or more illustrations).

So, talk to your sister’s doctor about her anxiety, and consider visiting with a counselor who can help you plan interesting activities and some simple coping strategies. For more information about behaviors or planning activites, visit the Caregiver’s Corner section of the Alzheimer's Association website by clicking here. You can also contact the HELPline for more information by calling 713-314-1313.

Melinda Stanley, Ph.D., is Professor of Psychiatry and Behavioral Sciences and Head of the Division of Psychology in the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine. She also holds the McIngvale Family Chair in Obsessive Compulsive Disorder Research. Dr. Stanley is a clinical psychologist whose research interests involve the identification and treatment of anxiety and depressive disorders in older adults. She is currently conducting studies that address the treatment of anxiety and depression in primary care and community settings where older patients with mental health problems often present for care. Dr. Stanley is nationally known for her research in this domain, and her work has been funded by the National Institute of Mental Health (NIMH) and the Veterans’ Affairs South Central Mental Illness Research, Education, and Clinical Center (MIRECC).