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Anxiety: a hidden element in dementia

  • Vellingiri Raja Badrakalimuthu and Andrew F. Tarbuck

Anxiety has reported prevalence rates between 38 and 72% among people with dementia. It has a negative impact on cognitive impairment and is associated with agitation and poor quality of life. The presence of excessive anxiety can be difficult to establish in people with dementia, especially when expressive or receptive speech is impaired. Unfortunately, there is a lack of research on the treatment of anxiety in dementia, and also on the wider issue of the management of anxiety disorders in old age. We explore the prevalence, presentation and diagnosis of anxiety in dementia and discuss the therapeutic options available.

Corresponding author
Dr V. R. Badrakalimuthu, Beechcroft, Fulbourn Hospital, Cambridge CB21 5EF, UK. Email:
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Aarsland, D, Cummings, JL, Larsen, JP (2001) Neuropsychiatric differences between Parkinson's disease with dementia and Alzheimer's disease. International Journal of Geriatric Psychiatry 16: 184–91.
Alexopoulos, GS, Raue, PJ, Dimitris, N et al (2011) Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Archives of General Psychiatry 68: 3341.
Alzheimer's Society (2011) Assistive technology – devices to help with everyday living. Alzheimer's Society (
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA.
Baldwin, D, Anderson, I, Nutt, D et al (2005) Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 19: 567–96.
Ballard, C, Neill, D, O'Brien, J et al (2000) Anxiety, depression and psychosis in vascular dementia: prevalence and associations. Journal of Affective Disorders 59: 97106.
Banerjee, S, Smith, SC, Lamping, DL et al (2006) Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. Journal of Neurology, Neurosurgery and Psychiatry 77: 146–8.
Beekman, AT, Bremmer, MA, Deeg, DJH et al (1998) Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam. International Journal of Geriatric Psychiatry 13: 717–26.
Bierman, EJM, Comijs, HC, Jonker, C et al (2009) The effect of anxiety and depression on decline of memory function in Alzheimer's disease. International Psychogeriatrics 21: 1142–7.
Bjelland, I, Dahl, AA, Haug, TT et al (2002) The validity of hospital anxiety and depression scale: an updated literature review. Journal of Psychosomatic Research 52: 6977.
Bohm, C, Robinson, DS, Gammans, RE et al (1990) Buspirone therapy in anxious elderly patients: a controlled clinical trial. Journal of Clinical Psychopharmacology 10: 47S51S.
Chen, JC, Borson, S, Scanlan, JM (2000) Stage-specific prevalence of behavioural symptoms in Alzheimer's disease in multi-ethnic community sample. American Journal of Geriatric Psychiatry 8: 123–33.
Cohen, D, Luchins, D, Eisdorfer, C et al (1990) Caring for relatives with Alzheimer's disease: the mental health risks to spouses, adult children and other family caregivers. Behavior, Health, and Aging 1: 171–82.
Cohen-Mansfield, J, Billig, N (1986) Agitated behaviour in the elderly: a conceptual review. Journal of American Geriatrics Society 34: 711–21.
Cummings, JL, Mega, M, Gray, K et al (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44: 2308–14.
Derousene, C, Rapin, J, Lacomblez, L et al (2004) Memory complaints in 200 subjects meeting the diagnostic criteria for age-associated memory impairment: psychoaffective and cognitive correlates. Psychology and Neuropsychiatry 2: 6774.
Evans, S (2004) A survey of provision of psychological treatments to older adults in the NHS. Psychiatric Bulletin 28: 411–4.
Foy, A, O'Connell, D, Henry, D et al (1997) Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients. JAMA 278: 2731.
Gallacher, J, Bayer, A, Fish, M et al (2009) Does anxiety affect risk of dementia? Findings from Caerphilly prospective study. Psychosomatic Medicine 71: 659–66.
Gambi, F, De Berardis, D, Campanella, D et al (2005) Mirtazapine treatment of generalised anxiety disorder: a fixed dose, open-labelled study. Journal of Psychopharmacology 19: 483–7.
Gauthier, S, Feldman, H, Hecker, J et al (2002) Efficacy of donepezil on behavioural symptoms in patients with moderate to severe Alzheimer's disease. International Psychogeriatrics 14: 389404.
Gorenstein, E, Papp, L (2007) Cognitive-behavioural therapy for anxiety in the elderly. Current Psychiatry Reports 9: 20–5.
Hancock, GA, Woods, B, Challis, D et al (2006) The needs of older people with dementia in residential care. International Journal of Geriatric Psychiatry 21: 43–9.
Katz, IR, Reynolds, CF, Alexopoulos, GS et al (2002) Venlafaxine ER as a treatment for generalised anxiety disorder in older adults: pooled analysis of five randomised placebo controlled trials. Journal of American Geriatric Society 50: 1825.
Kinrys, G, Wygant, L (2005) Anticonvulsants in anxiety disorders. Current Psychiatry Reports 7: 258–67.
LaBarge, E (1993) A preliminary scale to measure the degree of worry among mildly demented Alzheimer disease patients. Physical & Occupational Therapy in Geriatrics 11: 4357.
Martinón-Torres, G, Fioravanti, M, Grimley Evans, J (2004) Trazodone for agitation in dementia. Cochrane Database of Systematic Reviews issue 4: CD004990.
McIntyre, A, Gendron, A, McIntyre, A (2006) Quetiapine adjunct to selective serotonin reuptake inhibitors or venlafaxine in patients with major depression, comorbid anxiety, and residual depressive symptoms: a randomized, placebo-controlled pilot study. Depression and Anxiety 24: 487–94.
Mendez, MF, McMurtray, A, Chen, AK et al (2006) Functional neuroimaging and presenting psychiatric features in frontotemporal dementia. Journal of Neurology, Neurosurgery and Psychiatry 77: 47.
Mintzer, JE, Brawman-Mintzer, O (1996) Agitation as a possible expression of generalised anxiety disorder in demented elderly patients: toward a treatment approach. Journal of Clinical Psychiatry 57 (suppl 7): 5563.
Mohlman, J, Gorenstein, EE, Kleber, M et al (2003) Standard and enhanced cognitive behaviour therapy for late-life generalised anxiety disorder: two pilot investigations. American Journal of Geriatric Psychiatry 11: 2432.
Montgomery, S, Chatamra, K, Pauer, L et al (2008) Efficacy and safety of pregabalin in elderly people with generalised anxiety disorder. British Journal of Psychiatry 193: 389–4.
Morinigo, A, Blanco, M, Labrador, J et al (2005) Risperidone for resistant anxiety in elderly patients. American Journal of Geriatric Psychiatry 13: 81–2.
Mynors-Wallis, L (2001) Problem-solving treatment in general psychiatric practice. Advances in Psychiatric Treatment 7: 417–25.
National Collaborating Centre for Mental Health (2006) Dementia: Supporting People with Dementia and their Carers in Health and Social Care (NICE Clinical Guideline 42). National Institute for Health and Clinical Excellence.
National Collaborating Centre for Mental Health (2009) Depression: The Treatment and Management of Depression in Adults (NICE Clinical Guideline 90). National Institute for Health and Clinical Excellence.
National Collaborating Centre for Mental Health, National Collaborating Centre for Primary Care (2011) Generalised Anxiety Disorder and Panic Disorder (with or without Agoraphobia) in Adults: Management in Primary Secondary and Community Care (NICE Clinical Guideline 113). National Institute for Health and Clinical Excellence.
Neal, M, Barton Wright, P (2003) Validation therapy for dementia. Cochrane Database of Systematic Reviews issue 3: CD001394.
Neutal, CI, Hirdes, JP, Maxwell, CJ et al (1996) New evidence on benzodiazepine use and falls: the time factor. Age and Ageing 24: 273–8.
Nordhus, IH, Pallesen, S (2003) Psychological treatment of late-life anxiety: an empirical review. Journal of Consulting and Clinical Psychology 71: 643–51.
Rabins, PV, Blacker, D, Rovner, BW et al (2007) American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition. American Journal of Psychiatry 164 (suppl 12): 556.
Rozzini, L, Chilovi, BV, Peli, M et al (2009) Anxiety symptoms in mild cognitive impairment. International Journal of Geriatric Psychiatry 24: 300–5.
Scottish Intercollegiate Guidelines Network (2006) Management of Patients with Dementia: A National Clinical Guideline (no. 86). SIGN.
Seignourel, PJ, Kunik, ME, Snow, L et al (2008) Anxiety in dementia: a critical review. Clinical Psychological Review 28: 1071–82.
Shah, A, Wadoo, O, Latoo, J (2010) Psychological distress in carers of people with mental disorders. British Journal of Medical Practitioners 3: a327.
Shankar, KK, Walker, M, Frost, D (1999) The development of a valid and reliable scale for rating anxiety in people with dementia (RAID). Aging & Mental Health 3: 3949.
Sink, KC, Holden, KF, Yaffe, K (2005) Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 293: 596608.
Spector, A, Davies, S, Woods, B et al (2000) Reality orientation for dementia: a systematic review of the evidence of effectiveness for randomised controlled trials. Gerontologist 40: 206–12.
Spector, A, Thorgrimsen, L, Woods, B et al (2003) Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. British Journal of Psychiatry 183: 248–54.
Starkstein, SE, Jorge, R, Petracca, G et al (2007) The construct of generalised anxiety disorder in Alzheimer disease. American Journal of Geriatric Psychiatry 15: 42–9.
Thompson, S, Herrmann, N, Rapoport, MJ et al (2007) Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a meta analysis. Canadian Journal of Psychiatry 52: 248–55.
Tsuang, MT (1978) Genetic counseling for psychiatric patients and their families. American Journal of Psychiatry 135: 1465–75.
Twelftree, H, Qazi, A (2006) Relationship between anxiety and agitation in dementia. Aging & Mental Health 10: 362–7.
Wagner, AK, Zhang, F, Soumerai, SB et al (2004) Benzodiazepine use and hip fractures in the elderly: who is at greatest risk? [Article in German] Archives of Internal Medicine 164: 1567–72.
Wetterling, T, Backhaus, J, Junghanns, K (2002) Addiction in the elderly – an underestimated diagnosis in clinical practice? Nervenarzt 73: 861–6.
Wilson, SJ, Nutt, DJ, Alford, C et al (2010) British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. Journal of Psychopharmacology (BAP Consensus Guidelines Special Issue): 125.
Wing, JK, Babor, T, Brugha, T et al (1990) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47: 589–93.
Woods, B, Spector, AE, Jones, CA et al (2005) Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews issue 2: CD001120.
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Anxiety: a hidden element in dementia

  • Vellingiri Raja Badrakalimuthu and Andrew F. Tarbuck
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