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How To Treat Anxiety In Dementia Patients

Some Practical Tips That Can Help You Deal With Anxiety In Dementia Patients

Approaches to treating anxiety in Alzheimer’s disease

There are some tips that can really help, especially when it comes to medications meat to handle anxiety. Some of the things to remember include:

  • Before you choose to medicate, first identify why the elderly person is getting anxious and what is making it worse. Try non-drug approaches before anything else.
  • Consider treating constipation or pain because sometimes such issues can be overlooked in the patients. Since a dementia patient cannot be able to articulate the pain they are feeling, acetaminophen can be given. Titrate drugs can also be given so that the patient can have a softer bowel movement every couple of days.
  • Some medications work better on certain individuals than others. as such, if you do choose to use medications, you may have to try different ones before you can find one what actually works
  • Benzodiazepines and antipsychotics usually work quickly. However, they work mainly through chemical restraint and sedation. They should be kept on a low dose as much as possible.
  • Benzodiazepines can increase falling risks than other drugs and can be habit forming. They may not help with paranoia, delusions, or hallucinations. For this fact, when geriatricians need something that acts fast, they would probably give antipsychotics instead of benzodiazepines.
  • Even though the antidepressants take a longer time to work, they are well tolerated.
  • Dementia drugs can also be tried out because they are well tolerated.
  • Key Message For Patients Caregivers And Providers

    The federal government has long targeted use of these medications in nursing homes, but not in people who live at home or in less-regulated settings like assisted living facilities.

    Dementia comes with lots of behavioral issues, from changes in sleep and depression to apathy and withdrawal, and providers, patients and caregivers may naturally seek to address these through medications, says Donovan Maust, M.D., M.S., the lead author of the study and an associate professor of psychiatry at Michigan Medicine, U-Ms academic medical center.

    But the evidence supporting the use of many of them in people with dementia is pretty thin, he says, while there is a lot of evidence about the risks, especially when there are multiple medications layered on top of one another.

    Maust and his colleagues suggest that regular prescription drug reviews could help spot risky combinations, especially ones of three or more drugs that act on the brain and nervous system. Medicare covers such appointments with providers or pharmacists.

    It appears that we have a lot of people on a lot of medications without a very good reason, he says.

    Give New Interventions A Try

    Even though research is still emerging, studies suggest that psychosocial interventions are currently the best and lowest-risk treatments for depression and anxiety in older adults with cognitive impairment. A broad range of supportive approaches for nonmedication treatments exists, and should be used if available as a first-line treatment.

    Also Check: Early Stage Dementia Treatment

    Anxiety And Older Adults: Overcoming Worry And Fear

    Anxiety and Older Adults

    Overcoming Worry and Fear

    Feeling anxious or nervous is a common emotion for people of all ages and a normal reaction to stress. Feeling anxious can help us handle problems and strange situations, and even avoid danger. It is normal to feel anxious about illnesses, new social interactions, and frightening events. But when one feels anxious often and the anxiety is overwhelming and affects daily tasks, social life, and relationships, it may be an illness.

    Anxiety is a common illness among older adults, affecting as many as 10-20 percent of the older population, though it is often undiagnosed. Phobiawhen an individual is fearful of certain things, places or eventsis the most typical type of anxiety. Among adults, anxiety is the most common mental health problem for women, and the second most common for men, after substance abuse.

    Untreated anxiety can lead to cognitive impairment, disability, poor physical health, and a poor quality of life. Fortunately, anxiety is treatable with prescription drugs and therapy.

    WHAT IS ANXIETY?

    An anxiety disorder causes feelings of fear, worry, apprehension, or dread that are excessive or disproportional to the problems or situations that are feared. There are several types of anxiety disorders.

    WHY SHOULD AN OLDER ADULT BE CONCERNED ABOUT ANXIETY?

    WHAT LEADS TO ANXIETY DISORDER?

    A number of things can contribute to an anxiety disorder:

    SIGNS OF ANXIETY DISORDER

    WHO CAN HELP?

    MEDICATION

    Do Not Try To Stop A Person Who Wants To Leave A Room

    Management of Anxiety in Dementia Patients

    Staying in one place for long periods may result in behavior problems in the dementia patient. It is essential to have a safe environment where they can enjoy the outdoors without any problem. When someone tries to leave a room, do not force them to stop. Doing this may result in an extreme reaction such as severe distress or injuries.

    Instead, it is best to accompany the patient so that they are safe. You can even suggest going for a drive around the block so that they can experience a new environment for a short period. If they do not want company, just let them go but stay close by to make sure that the patient is safe at all times.

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    Medications That Can Be Used To Handle Anxiety In Elderly With Dementia

    One of the most difficult situations to deal with when handling a dementia patient is when they are acting anxious or agitated. These issues go beyond thinking and memory. These issues include things like:

    Sleep disturbances

    Disinhibited behavior, meaning the person can say or do things that are inappropriate socially speaking

    Wandering and pacing

    Agitation

    Irrational beliefs, paranoid behaviors, and delusions

    These neuropsychiatric symptoms can be hard to deal with and they are one of the most challenging things that caregivers can deal with when caring for dementia patients. There is no specific drug that can be used for the treatment of dementia, but development can be slowed down and symptoms treated.

    Anxiety And Dementia Subtype

    Six studies compared anxiety prevalence in distinct, well-defined types of dementia . In one study , rates of OCD, phobia, and GAD did not differ between AD and vascular dementia . Among four studies that examined rates of anxiety symptoms in AD and VaD, two found greater anxiety in VaD , and the other two did not find any significant difference . In both studies with null findings, anxiety was qualitatively greater in the AD group. Moreover, in one study , sample size was relatively small , and in the other study , rates of anxiety symptoms were unusually low . Thus, anxiety symptoms appear greater in VaD than in AD. Compared to AD, rates of anxiety symptoms may be greater in fronto-temporal dementia and similar in dementia associated with Parkinsonâs disease .

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    No Easy Solutions But Improvement Is Usually Possible

    As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.

    Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.

    If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.

    But I hope this information will enable you to make more informed decisions. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.

    To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors

    And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.

    Paranoia Delusion And Hallucinations

    Managing Dementia and Anxiety

    Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle.

    Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.

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    Classes Of Drugs Studied

    Antipsychotics have received the most attention for their risk to people with dementia, and 47% of those taking three or more of the medications in the study received at least one antipsychotic, most often Seroquel .

    Even though such antipsychotics arent approved for people with dementia, theyre often prescribed to such patients for agitation and sleep issues, and more, Maust notes.

    But two other classes of drugs were even more commonly prescribed to patients in the CNS polypharmacy group. Nearly all of those on three or more of the medications were taking an antidepressant, and 62% were taking an anti-seizure medication.

    One drug in that last class, gabapentin, accounted for one-third of all the days of prescription supply that the patients in the study received during the study period.

    While gabapentin is approved to treat epilepsy, few of these older adults had a seizure disorder. The vast majority of prescriptions were probably for other reasons because it is commonly prescribed off-label as a pain medication or to help with anxiety, Maust explains.

    Another 41% of the people in the three-or-more medication group were taking a benzodiazepine, such as lorazepam , often used for anxiety or agitation in people with dementia.

    Mausts past work on benzodiazepine prescribing in older adults focused on long-term use, variation by geographic region, and the effects of national efforts to reduce the use of such drugs because of their risks.

    Behavioral Symptoms Associated With Dementia

    In addition to the cognitive symptoms, most people with dementia exhibit what are called neuropsychiatric or neurobehavioral syndromes, more commonly known as behavioral and psychological symptoms. These symptoms can have a range of manifestations such as depression, anxiety, irritability, apathy, agitation or aggression, pacing, sleep disturbances, hallucinations, paranoia, and delusions. Apathy and social withdrawal are often apparent early in the disease course and become increasingly common with disease progression. In the case above, Mr. R first demonstrated apathy and decreased interest in social activities, and went on to develop anxiety, irritability, verbal outbursts, and pacing these are examples of neuropsychiatric symptoms.

    It is very common for patients with dementia to have one or more neuropsychiatric symptoms. For example, depression is seen in up to 40% of patients with Alzheimer’s disease, and apathy occurs in up to 90% of patients in the later stages of the disease. Visual hallucinations are present in half of patients with Lewy-body dementia, which is also frequently accompanied by agitation or even physical aggression. Together with the cognitive symptoms of dementia, neuropsychiatric symptoms lead to an increased need for hospitalization and/or placement of patients in nursing facilities, as well as significant emotional distress and worsening quality of life for patients and their families.

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    Seizures & Mood Stabilizers

    Common Drugs Taken:

    • Valproic acid
    • Uses: May be used to treating aggression. Has a sedative effect on agitated physical and verbal behaviors.
    • Risks and Side Effects: Confusion or worsened thinking, dizziness, difficulty walking or balancing, tremor and the development of other Parkinsonism symptoms, and gastrointestinal symptoms including nausea, vomiting, and/or diarrhea.
    • Non-Drug Treatments: Identifying underlying causes, promoting physical and emotional comfort, and changing the environment.

    Do Try To Be Forgiving And Patient

    Seven

    Do not forget that dementia is the condition that results in irrational behavior and causes dementia sufferers to act the way they do. The patients demand plenty of patience and forgiveness from the people looking after them. Have the heart to let things go instead of carrying grudges around for something that the patient may not be in control of.

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    Differentiating Anxiety From Dementia

    One of the difficulties in studying anxiety in dementia is the symptom overlap between the two conditions. For Generalized Anxiety Disorder , in particular, possible symptoms include restlessness, being easily fatigued and difficulty concentrating, all of which can occur in dementia without the presence of an anxiety disorder. Unfortunately, the hallmark of GAD, excessive anxiety or worry that is difficult to control, cannot always be assessed reliably in individuals with dementia, particularly those with expressive or receptive language difficulties. Thus, a difficult question for researchers and clinicians is whether anxiety symptoms that could potentially be accounted for by the presence of dementia should be used to diagnose an anxiety disorder.

    Out of these three potential strategies, the first one, which ignores the potential overlap between symptoms of anxiety and dementia, is likely to inflate rates of anxiety disorders and symptoms. Selecting items that minimize potential overlap is a preferred approach. Using revised diagnostic criteria for anxiety disorders in dementia, as has been proposed by Starkstein et al. , is also promising. Such an approach, however, should be based on consensus guidelines from experts in the field in addition to empirical data, as exemplified by the provisional diagnostic criteria for depression in Alzheimerâs Disease .

    What Are Anxious Behaviours

    Changes in the behaviour of people with dementia are very common. Some people may become worried and anxious, but are unable to tell you what is upsetting them. The person may be restless and pace or fidget. It can sometimes seem as if they are stuck in a groove and unable to move on. They may cling to you if you attempt to leave the room, or the house.

    Another common anxious behaviour is shadowing following you closely around the house like a shadow. Some families and carers have described the stress of being shadowed constantly, unable to find any privacy, even in the toilet.

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    How Can Caregivers Best Help

    Scheduling pleasant activities, helping a loved one structure their day in a meaningful way, and problem-solving around issues contributing to distress may all help improve mood and decrease anxiety. In addition, it is important to help your loved one keep their brain sharp by eating a healthy Mediterranean diet, , and yes, .

    Types Of Medication To Treat Anxiety

    Dementia and Anxiety: What you can do

    There are certainly cases when you will have to administer medications to a patient with dementia. Avoid getting anxiety medication over the counter since there are lots of things that need to be assessed.

    There are different best over the counter anxiety medication that can be helpful to patients dealing with anxiety, but most of them are not recommended for dementia patients. Most common drugs that can be administered to the patients include:

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    Best Anti Anxiety Medication For Elderly With Dementia

    People with dementia can be upset or get anxious quite easily. It is also normal for people with such a condition to be rather restless and have issues sleeping. This is why you find them pacing up and down.

    Anxiety is an issue that makes such elderly patients not be able to handle the daily routines and they can become very harmful to their loved ones or their caregivers. The best anti-anxiety medication for elderly with dementia should be administered to help them cope.

    One of the greatest triggers of anxiety in such patients is change. It may be because the routine changes, or she /he is in new surroundings, or that he/she is surrounded by new faces.

    It may also be because of fatigue or fear. Anxiety can also be because of infections or other underlying medical issues. If such a thing happens to a loved one and you are not able to point out the reason for the issue, you should seek help from a doctor to establish the real cause.

    Reminiscence And Life Story Work

    Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.

    Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

    These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.

    You’ll find more details about these treatments in the Alzheimer’s Society’s dementia guide.

    Read Also: Purple Ribbon Alzheimer’s

    Reasons To Incorporate Dementia Medications

    As your friend or family member progresses through the stages of dementia, they might need a bit of help with their changing emotions and behaviors. Various stages of dementia can cause your relative to easily become agitated, confused or upset. They might become aggressive or anxious. They might also experience hallucinations or have episodes of depression. All of these symptoms are part of dementia and can come and go.

    Its important to remember that there is a reason why they are acting or responding in a certain way. Cognitive impairment has led to changes in the way your family member thinks, feels and behaves. In some cases, your friend or relatives symptoms can become more intense and potentially cause harm to themselves or to those providing wellness support. If your friend or family member cant receive the support they need and deserve, they wont be able to live their best life.

    Medication can help them feel more comfortable and to experience a higher quality of life, whether living at home, in assisted living or at a dedicated memory care community.

    The Pros And Cons Of Cbd Oil For Dementia

    New anxiety

    The Pros

    • Studies conducted on humans and animals have revealed CBDs therapeutic properties that may help treat the various conditions classified under dementia.
    • Medications for dementia have several side effects, including nausea, vomiting, diarrhea, and hallucinations, among others. Meanwhile, CBD generally has an excellent safety profile as its side effects are minimal. The most common are diarrhea, tiredness, and changes in weight or appetite.
    • The World Health Organization has not recorded any case of CBD dependence in humans . Hence, it is not a substance that has the potential for abuse.
    • As long as state laws allow CBD use, buying CBD products does not require a prescription.

    The Cons

    • There is a need for further research on medical cannabis-related products, like CBD, in the treatment of dementia and its many diseases.
    • There is a need for a standard dosage for CBD when used as a dementia treatment. Currently, the United States Food and Drug Administration has not approved its use for mental health-related conditions and other ailments except for epilepsy.
    • Cholinesterase inhibitors are typically prescribed for dementia treatment. Some of the commonly used cholinesterase inhibitors include donepezil and galantamine. These are both metabolized by cytochrome P450. Caution should be taken when using CBD with these dementia medications because of possible drug interactions. CBD may reduce the efficacy of these medications as it can inhibit these liver enzymes.

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