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Alzheimer's Disease and Anxiety

Anxiety is Common in Early- to Mid-Stage Alzheimer's Disease, But There are Ways to Lessen the Distress

By James Clyde Sellman, Ph.D.

Updated July 08, 2008

(LifeWire) - Although memory loss and impaired thinking are its hallmarks, Alzheimer's disease also causes other problems, including anxiety. This feeling of uneasiness, fear, and apprehension occurs in many who have Alzheimer's, particularly during the early and middle stages of the disease.

Anxiety can increase distress for both those with the disease and their caregivers, but a number of pharmaceutical and behavioral strategies can help.

Recognizing Anxiety

Anxiety among those with Alzheimer's can be hard to recognize. Typical anxiety symptoms include excessive worry, tenseness, sweating, and a racing heartbeat. But Alzheimer's anxiety can take other forms. Social withdrawal or decreased engagement in once-pleasurable activities -- typically associated with depression -- can also reflect anxiety. Alzheimer's anxiety often occurs together with depression and irritability.

Angry outbursts or following family members or caregivers from room to room may occur because the individual no longer fully understands what to do or expect -- or what's expected of him.

Behavioral Approaches

Once you note signs of anxiety, the Alzheimer's Association recommends trying to identify the cause. It may be a reaction to the Alzheimer's diagnosis or to perceiving its inroads. Anxiety may involve fear of being alone or particular stresses, such as financial worries. Change is often a problem, such as a new caregiver, hospitalization, or travel. Parts of the daily routine, such as bathing or changing clothes, may induce anxiety.

Once you identify the sources, you can try to minimize their impact. It's best to start with nondrug, behavioral management. Drugs have side effects, and since most people with Alzheimer's are older, they're likely to be taking other medications, increasing the risk for drug interactions.

Sometimes distraction or redirecting the individual's attention is enough. Avoid becoming confrontational or overexcited. Simplifying the environment and daily routine can also help. Other useful strategies include allowing for rest and quiet between potentially stressful activities, and making sure there's adequate light in the evening to reduce the potential for confusion. Structured activities -- familiar music, pets, walking, or light exercise -- can also be calming.

Finally, experts advise caring for the caregivers -- through support, respite care, and for those who are still caring for someone at home, through the additional use of home care aides or adult day care.

Pharmaceutical Treatment

The FDA hasn't approved any drug specifically for Alzheimer's anxiety. General anti-anxiety medications -- such as Ativan (lorazepam) or Serax (oxazepam) -- are short-term solutions. However, they can cause physical unsteadiness and heighten confusion and memory impairment. If the person has anxiety and depression, it may help to use antidepressants, for example, selective serotonin re-uptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Zoloft (sertraline). Desyrel (trazodone), which affects serotonin but is not an SSRI, may also be beneficial.

Alzheimer's disease disrupts neurotransmitters, which are the chemicals that carry messages between brain cells. For behavioral symptoms, the cholinergic system, which is involved in emotions and mood (including anxiety), is especially important.

Various drugs known as cholinesterase inhibitors, which counter the loss of cholinergic neurotransmitters, help slow the cognitive impact of Alzheimer's disease. A 2007 review in The Consultant Pharmacist -- summarizing research on various "cognitive enhancers" for Alzheimer's behavioral symptoms -- emphasized that cholinesterase inhibitors can benefit behavioral as well as cognitive problems.

Study author Lisa J. Miller reported that Aricept (donepezil), the most studied of these medications, shows "the greatest positive effects." But she noted that benefits were "harder to demonstrate for mild-to-moderate" symptoms. In addition, the effects of specific medications can vary from person to person.

Among alternative therapies, Ginkgo biloba, a tree long valued in China for its medicinal properties, has shown some promise. Several European studies suggest that ginkgo may offer both cognitive and behavioral benefits, including alleviation of anxiety.

Sources:

Alexopoulos G.S., D.V. Jeste, H. Chung, D. Carpenter, R. Ross, J.P. Docherty. "The Expert Consensus Guideline Series. Treatment of Dementia and Its Behavioral Disturbances. Introduction: Methods, Commentary and Summary." Postgraduate Medical Journal. Jan. (2005) 6-22. <http://www.ncbi.nlm.nih.gov/pubmed/17203561>

"Alzheimer's Therapeutic Activities" ALZInfo.org. 2008. Fisher Center for Alzheimer's Research Foundation. 9 June 2008, <http://www.alzinfo.org/alzheimers-treatment-therapeutic.asp>

"Behavioral Symptoms." ALZ.org. 20 Mar 2008. Alzheimer's Association. 7 June 2008.
<http://www.alz.org/professionals_and_researchers_behavioral_symptoms_pr.asp>

"Dementia: Drugs Used to Relieve Behavioural Symptoms." Alzheimers.org.uk. Mar 2004. Alzheimer's Society [UK]. 6 June 2008. <http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=110.>

Mazza M., A. Capuano, P. Bria, S. Mazza. "Ginkgo Biloba and Donepezil: A Comparison in the Treatment of Alzheimer's Dementia in a Randomized Placebo-Controlled Double-Blind Study." European Journal of Neurology. 13:9 (2006) 981-5.
<http://www.blackwell-synergy.com/doi/full/10.1111/j.1468-1331.2006.01409.x?prevSearch=allfield%3A%28Ginkgo+Biloba+and+Donepezil%29>

Miller LJ. "The use of cognitive enhancers in behavioral disturbances of Alzheimer's disease." Consult Pharm. 2007 Sep;22(9):754-62. Petrovic M., C. Hurt, D. Collins, A. Burns, V. Camus, R. Liperoti, A. Marriott, F. Nobili, P. Robert, M. Tsolaki, B. Vellas, F. Verhey, E.J. Byrne. "Clustering of behavioural and psychological symptoms in dementia (BPSD): a European Alzheimer's disease consortium (EADC) study." Acta Clinica Belga. 62:6 (2007) 426-32.

Porter, Verna R., William G. Buxton, Lynn A. Fairbanks, Tony Strickland, Susan M. O'Connor, Susan Rosenberg-Thompson and Jeffrey L. Cummings. "Frequency and Characteristics of Anxiety Among Patients with Alzheimer's Disease and Related Dementias." Journal of Clinical Neuropsychiatry and Clinical Neurosciences. 15 (2003) 180-186. <http://neuro.psychiatryonline.org/cgi/reprint/15/2/180>

"The Changing Brain in Alzheimer's Disease." National Institute on Aging. 29 Aug. 2006. U.S. National Institutes of Health. 9 Jun 2008. <http://www.nia.nih.gov/Alzheimers/Publications/UnravelingTheMystery/Part1/ChangingBrainInAlzheimer.htm.>

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. James Clyde Sellman is a freelance writer and editor in Newton, Mass., who specializes in a broad range of consumer health topics. His work has appeared in the Harvard Health Letter, Harvard Women's Health Watch, Revolution Health (www.revolutionhealth.com), Infertility Source (www.infertilitysource.com) and My Student Body.com (www.mystudentbody.com).

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