Dement Neurocogn Disord.  2017 Jun;16(2):33-39. 10.12779/dnd.2017.16.2.33.

Anxiety in Dementia

Affiliations
  • 1Department of Neurology, Hyoja Geriatric Hospital, Yongin, Korea. kwakdr@gmail.com
  • 2Department of Neurology, Seoul Veterans Hospital, Seoul, Korea.
  • 3Department of Psychiatry, College of Medicine, Catholic Kwandong University, Gangneung, Korea.

Abstract

Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affecting from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presentation of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer's disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. However, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia.

Keyword

anxiety; dementia; vascular dementia; Alzheimer's disease

MeSH Terms

Alzheimer Disease
Anxiety Disorders
Anxiety*
Caregivers
Dementia*
Dementia, Vascular
Depression
Diagnosis
Humans
Prevalence
Quality of Life

Reference

1. Shankar KK, Orrell MW. Detecting and managing depression and anxiety in people with dementia. Curr Opin Psychiatry. 2000; 13:55–59.
Article
2. Porter VR, Buxton WG, Fairbanks LA, Strickland T, O'Connor SM, Rosenberg-Thompson S, et al. Frequency and characteristics of anxiety among patients with Alzheimer's disease and related dementias. J Neuropsychiatry Clin Neurosci. 2003; 15:180–186. PMID: 12724459.
Article
3. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache County study on memory in aging. Am J Psychiatry. 2000; 157:708–714. PMID: 10784462.
Article
4. Gibbons LE, Teri L, Logsdon R, McCurry SM, Kukull W, Bowen J, et al. Anxiety symptoms as predictors of nursing home placement in patients with Alzheimer's disease. J Clin Geropsychol. 2002; 8:335–342.
5. Beekman AT, Bremmer MA, Deeg DJ, van Balkom AJ, Smit JH, de Beurs E, et al. Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam. Int J Geriatr Psychiatry. 1998; 13:717–726. PMID: 9818308.
Article
6. Ballard C, Neill D, O'Brien J, McKeith IG, Ince P, Perry R. Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord. 2000; 59:97–106. PMID: 10837878.
Article
7. Mendez MF, McMurtray A, Chen AK, Shapira JS, Mishkin F, Miller BL. Functional neuroimaging and presenting psychiatric features in frontotemporal dementia. J Neurol Neurosurg Psychiatry. 2006; 77:4–7. PMID: 16043457.
Article
8. Chen JC, Borson S, Scanlan JM. Stage-specific prevalence of behavioral symptoms in Alzheimer's disease in a multi-ethnic community sample. Am J Geriatr Psychiatry. 2000; 8:123–133. PMID: 10804073.
Article
9. Aarsland D, Cummings JL, Larsen JP. Neuropsychiatric differences between Parkinson's disease with dementia and Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16:184–191. PMID: 11241724.
Article
10. Seignourel PJ, Kunik ME, Snow L, Wilson N, Stanley M. Anxiety in dementia: a critical review. Clin Psychol Rev. 2008; 28:1071–1082. PMID: 18555569.
Article
11. Tanaka H, Hashimoto M, Fukuhara R, Ishikawa T, Yatabe Y, Kaneda K, et al. Relationship between dementia severity and behavioural and psychological symptoms in early-onset Alzheimer's disease. Psychogeriatrics. 2015; 15:242–247. PMID: 25737233.
Article
12. Kwak YT, Yang YS, Kwak SG. Clinical characteristics of behavioral and psychological symptoms in patients with drug-naïve Alzheimer's disease. Dement Neurocogn Disorder. 2012; 11:87–94.
Article
13. Brodaty H, Connors MH, Xu J, Woodward M, Ames D. PRIME study group. The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. J Am Med Dir Assoc. 2015; 16:380–387. PMID: 25687925.
Article
14. McClive-Reed KP, Gellis ZD. Anxiety and related symptoms in older persons with dementia: directions for practice. J Gerontol Soc Work. 2011; 54:6–28. PMID: 21170777.
Article
15. Starkstein SE, Jorge R, Petracca G, Robinson RG. The construct of generalized anxiety disorder in Alzheimer disease. Am J Geriatr Psychiatry. 2007; 15:42–49. PMID: 17194814.
Article
16. Neville C, Teri L. Anxiety, anxiety symptoms, and associations among older people with dementia in assisted-living facilities. Int J Ment Health Nurs. 2011; 20:195–201. PMID: 21492359.
Article
17. Bergh S, Selbæk G. The prevalence and the course of neuropsychiatric symptoms in patients with dementia. Nor Epidemiol. 2012; 22:225–232.
Article
18. Bierman EJ, Comijs HC, Jonker C, Beekman AT. Symptoms of anxiety and depression in the course of cognitive decline. Dement Geriatr Cogn Disord. 2007; 24:213–219. PMID: 17690554.
Article
19. Calleo J, Stanley M. Anxiety disorders in later life: differentiated diagnosis and treatment strategies. Psychiatr Times. 2008; 25:24–27.
20. Calleo JS, Kunik ME, Reid D, Kraus-Schuman C, Paukert A, Regev T, et al. Characteristics of generalized anxiety disorder in patients with dementia. Am J Alzheimers Dis Other Demen. 2011; 26:492–497. PMID: 22062223.
Article
21. Rozzini L, Chilovi BV, Peli M, Conti M, Rozzini R, Trabucchi M, et al. Anxiety symptoms in mild cognitive impairment. Int J Geriatr Psychiatry. 2009; 24:300–305. PMID: 18759379.
Article
22. Bierman EJ, Comijs HC, Jonker C, Scheltens P, Beekman AT. The effect of anxiety and depression on decline of memory function in Alzheimer's disease. Int Psychogeriatr. 2009; 21:1142–1147. PMID: 19615124.
Article
23. Gallacher J, Bayer A, Fish M, Pickering J, Pedro S, Dunstan F, et al. Does anxiety affect risk of dementia? Findings from the Caerphilly prospective study. Psychosom Med. 2009; 71:659–666. PMID: 19553290.
Article
24. Derouesné C, Rapin JR, Lacomblez L. [Memory complaints in 200 subjects meeting the diagnostic criteria for age-associated memory impairment: psychoaffective and cognitive correlates]. Psychol Neuropsychiatr Vieil. 2004; 2:67–74. PMID: 15683970.
25. Breitve MH, Hynninen MJ, Brønnick K, Chwiszczuk LJ, Auestad BH, Aarsland D, et al. A longitudinal study of anxiety and cognitive decline in dementia with Lewy bodies and Alzheimer's disease. Alzheimers Res Ther. 2016; 8:3. PMID: 26812908.
Article
26. Somme J, Fernández-Martínez M, Molano A, Zarranz JJ. Neuropsychiatric symptoms in amnestic mild cognitive impairment: increased risk and faster progression to dementia. Curr Alzheimer Res. 2013; 10:86–94. PMID: 23016837.
Article
27. Palmer K, Berger AK, Monastero R, Winblad B, Bäckman L, Fratiglioni L. Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology. 2007; 68:1596–1602. PMID: 17485646.
Article
28. Rosenberg PB, Mielke MM, Appleby BS, Oh ES, Geda YE, Lyketsos CG. The association of neuropsychiatric symptoms in MCI with incident dementia and Alzheimer disease. Am J Geriatr Psychiatry. 2013; 21:685–695. PMID: 23567400.
Article
29. Liu HC, Wang PN, Wang HC, Lin KN, Hong CJ, Liu CY, et al. Conversion to dementia from questionable dementia in an ethnic Chinese population. J Geriatr Psychiatry Neurol. 2007; 20:76–83. PMID: 17548776.
Article
30. Brodaty H, Heffernan M, Draper B, Reppermund S, Kochan NA, Slavin MJ, et al. Neuropsychiatric symptoms in older people with and without cognitive impairment. J Alzheimers Dis. 2012; 31:411–420. PMID: 22571979.
Article
31. Kessler RC, Gruber M, Hettema JM, Hwang I, Sampson N, Yonkers KA. Co-morbid major depression and generalized anxiety disorders in the national comorbidity survey follow-up. Psychol Med. 2008; 38:365–374. PMID: 18047766.
Article
32. Reisberg B, Auer SR, Monteiro IM. Behavioral pathology in Alzheimer's disease (BEHAVE-AD) rating scale. Int Psychogeriatr. 1996; 8(Suppl 3):301–308. discussion 351-354. PMID: 9154579.
Article
33. Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology. 1997; 48(5 Suppl 6):S10–S16.
Article
34. Shankar KK, Walker M, Frost D, Orrell MW. The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging Ment Health. 1999; 3:39–49.
Article
35. LaBarge E. A preliminary scale to measure the degree of worry among mildly demented Alzheimer disease patients. Phys Occup Ther Geriatr. 1993; 11:43–57.
Article
36. James I. Using a cognitive rationale to conceptualize anxiety in people with dementia. Behav Cogn Psychother. 1999; 27:345–351.
Article
37. Boot BP, Orr CF, Ahlskog JE, Ferman TJ, Roberts R, Pankratz VS, et al. Risk factors for dementia with Lewy bodies: a case-control study. Neurology. 2013; 81:833–840. PMID: 23892702.
Article
38. Mah L, Binns MA, Steffens DC. Alzheimer's Disease Neuroimaging Initiative. Anxiety symptoms in amnestic mild cognitive impairment are associated with medial temporal atrophy and predict conversion to Alzheimer disease. Am J Geriatr Psychiatry. 2015; 23:466–476. PMID: 25500120.
Article
39. Green KN, Billings LM, Roozendaal B, McGaugh JL, LaFerla FM. Glucocorticoids increase amyloid-beta and tau pathology in a mouse model of Alzheimer's disease. J Neurosci. 2006; 26:9047–9056. PMID: 16943563.
Article
40. Erickson K, Drevets W, Schulkin J. Glucocorticoid regulation of diverse cognitive functions in normal and pathological emotional states. Neurosci Biobehav Rev. 2003; 27:233–246. PMID: 12788335.
Article
41. Ramakers IH, Verhey FR, Scheltens P, Hampel H, Soininen H, Aalten P, et al. Anxiety is related to Alzheimer cerebrospinal fluid markers in subjects with mild cognitive impairment. Psychol Med. 2013; 43:911–920. PMID: 22954311.
Article
42. Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial. Br J Psychiatry. 2003; 183:248–254. PMID: 12948999.
43. Nordhus IH, Pallesen S. Psychological treatment of late-life anxiety: an empirical review. J Consult Clin Psychol. 2003; 71:643–651. PMID: 12924668.
Article
44. Spector A, Charlesworth G, King M, Lattimer M, Sadek S, Marston L, et al. Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial. Br J Psychiatry. 2015; 206:509–516. PMID: 25698766.
Article
45. Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2005; 19:567–596. PMID: 16272179.
Article
46. Neutel CI, Hirdes JP, Maxwell CJ, Patten SB. New evidence on benzodiazepine use and falls: the time factor. Age Ageing. 1996; 25:273–278. PMID: 8831871.
Article
47. Foy A, O'Connell D, Henry D, Kelly J, Cocking S, Halliday J. Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients. J Gerontol A Biol Sci Med Sci. 1995; 50:M99–M106. PMID: 7874596.
Article
48. Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005; 293:596–608. PMID: 15687315.
49. Katz IR, Reynolds CF 3rd, Alexopoulos GS, Hackett D. Venlafaxine ER as a treatment for generalized anxiety disorder in older adults: pooled analysis of five randomized placebo-controlled clinical trials. J Am Geriatr Soc. 2002; 50:18–25. PMID: 12028242.
Article
50. Gauthier S, Feldman H, Hecker J, Vellas B, Ames D, Subbiah P, et al. Efficacy of donepezil on behavioral symptoms in patients with moderate to severe Alzheimer's disease. Int Psychogeriatr. 2002; 14:389–404. PMID: 12670060.
51. National Collaborating Centre for Mental Health, National Collaborating Centre for Primary Care. Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care (NICE clinical guideline 113). London: National Institute for Health and Clinical Excellence;2011.
52. Clerici F, Vanacore N, Elia A, Spila-Alegiani S, Pomati S, Da Cas R, et al. Memantine effects on behaviour in moderately severe to severe Alzheimer's disease: a post-marketing surveillance study. Neurol Sci. 2012; 33:23–31. PMID: 21584738.
Article
53. Moríñigo A, Blanco M, Labrador J, Martín J, Noval D. Risperidone for resistant anxiety in elderly persons. Am J Geriatr Psychiatry. 2005; 13:81–82.
Article
54. McIntyre A, Gendron A, McIntyre A. 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. Depress Anxiety. 2007; 24:487–494. PMID: 17177199.
Article
55. Kwak YT, Yang YS, Jang HR. Understanding of antipsychotics in elderly patients with dementia. Dement Neurocogn Disord. 2015; 14:53–69.
Article
Full Text Links
  • DND
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr