When you think of Alzheimer’s, you probably associate symptoms with memory loss and confusion. Although these symptoms are most certainly hallmark signs, they are not the only issues in which Alzheimer’s patients suffer from. Of the many possible symptoms, anxiety can actually be one of the most debilitating.
The Connection Between Anxiety and Alzheimer’s
Whether you suffer from a mental health or degenerative condition, it’s important to note that anxiety is a feeling that’s normal among the general population. Acting as a reaction to stress, anxiety can even be a good thing. Whether it warns you to stay away from a dangerous situation or pushes you to achieve your goals, some level of stress and fear is healthy.
When these feelings become strong, persistent and debilitating, however, they can dramatically influence everyday life. Although anyone can suffer from an anxiety disorder, those with dementia are at a higher risk than those who do not suffer from cognitive impairment. In conjunction with other degenerative symptoms, anxiety can be highly problematic for these patients.
Biologically and psychologically, Alzheimer’s patients experience a lot on any given day. Both anxiety and agitation are common symptoms among these patients, affecting their quality of life. The actual cause of one’s anxiety may vary, as different medical conditions, drug interactions, and a wide range of other circumstances influence one’s ability to think.
When an individual has Alzheimer’s, their ability to process new information is often compromised and different stimuli can have a dramatic effect on their ability to cope. Whether a patient is moving into a new care facility, misperceiving threats, or are simply exhausted from trying to make sense of their environment, symptoms of anxiety often follow.
Although common, anxiety has not been well studied among this population in the past. In terms of prevalence, estimates vary from 25 percent to 71 percent — with generalized anxiety being the most common form among Alzheimer’s patients. When this co-morbidity exists, individuals experience more severe impairment and a reduced quality of life.
Among elderly individuals, symptoms of both depression and anxiety are often early indicators, which predict future cognitive decline. It has been suggested that the risk of developing Alzheimer’s disease may be up to 30 times greater among individuals who suffer from both mild impairment and anxiety.
How Anxiety Symptoms Differ Across Dementia Patients
Of course, Alzheimer’s is a form of dementia, which causes patients to progressively deteriorate. Although the most common form, it’s most certainly not the only type of dementia. Within one study, published in the Journal of Neuropsychiatry and Clinical Neuroscience, the prevalence of anxiety was assessed among various groups of patients.
Patients with Alzheimer’s were compared with those who suffered from frontotemporal dementia, vascular dementia, and normal control subjects. Using the anxiety subscale of the Neuropsychiatric Inventory and behavioral features, the relationship between anxiety and cognition were explored.
What they found, was that anxiety is more common among diverse forms of dementia. Among those with Alzheimer’s, symptoms of anxiety generally affect those who suffer from severe decline and those who developed Alzheimer’s at an earlier age. Overall, anxiety impacts the majority of Alzheimer’s patients — resulting in the use of certain medications.
Benzodiazepine and Alzheimer’s Risk
Before we jump into the types of medications you should take for anxiety when suffering from Alzheimer’s, it’s important to address the connection between benzodiazepine and one’s risk. Whether you have taken Xanax, Valium, or other related medication, usage may increase your risk of Alzheimer’s disease.
This study was reported in BMJ, as researchers linked cumulative doses of benzodiazepine with a higher risk of Alzheimer’s. Although researchers cannot say that benzodiazepine causes Alzheimer’s, the association is clear. To better understand this potential link, researchers studied nearly 2,000 men and women over the age of 66 years old.
They then randomly selected another 7,000 individuals who did not have Alzheimer’s disease, looking at prescription drug use during the five to six years before this disease developed. What they found, was that those who had taken benzodiazepine for three months or less, experienced approximately the same risk of developing Alzheimer’s as those who had never taken one of these drugs.
When taking this drug for three to six months, risk increased by 32 percent and when taking it for more than six months, one’s risk jumped to 84 percent. The type of drug was also relevant, as long-acting options, such as Valium and Dalmane, resulted in a greater risk than short-acting alternatives, such as Ativan and Xanax
Based on this connection, researchers acknowledge that the use of these medications, may be a sign that individuals are aiming to cope with two early warning signs of Alzheimer’s disease — increased anxiety and sleep issues. In this sense, their use may indicate that this disease is already in progress.
What Medications Should Alzheimer’s Patients Take For Anxiety?
Before any drugs are administered, it’s essential that physicians properly assess an Alzheimer’s patient. This will ensure that certain variables cannot be altered, based on alternative methods. In many cases, caregivers and family members will try other non-drug remedies first, such as social interaction or therapy.
If anti-anxiety drugs are required in order to reduce agitation and problematic behaviors, then it’s important that both the dose and duration are closely followed. Anti-anxiety drugs such as Ativan and Klonopin can cause adverse effects, including dizziness, sleepiness, further confusion, and even falls.
Based on these potential side effects, doctors generally advise patients to only take anti-anxiety medications for short periods of time. When aiming to treat both anxiety and agitation, atypical antipsychotics are often prescribed, however, these can increase one’s risk of heart attacks and stroke.
Overall, alternative psychotropic classes of medications, such as antidepressants and anticonvulsants have not been shown to be any more effective or safe. Using atypical antipsychotics is only recommended when symptoms are severe. Of course, if a patient is aggressive or delusional, they may harm another patient or themselves.
It’s important for both caregivers and nurses to understand how these medications affect elderly individuals, as they are more vulnerable to adverse effects. Within one study, older adults with dementia who were living in nursing homes, were taking at least one psychotropic medication; 66 percent were taking two; 36 percent were taking three; and 11 percent were taking four or more.
In order to exhaust all other resources, it’s important to try and better understand the cause of one’s anxiety and agitation. Sometimes, physical discomforts such as hunger or constipation can cause symptoms of anxiety, increasing agitated behavior. Next, psychiatric and psychosocial factors should be examined.
It is this holistic approach, that will reduce one’s reliance on medication, as other beneficial treatments may be available. Whether you adjust noise levels or boredom, there are many modifications that can be made before relying on potent medications that may increase one’s risk of injury.
Once all options have been explored and symptoms of anxiety are still apparent, then behavioral modifications and/or medication may need to be offered. This will simply provide relief and help to better manage these problematic and distressing symptoms. As mentioned, if a patient places others in danger, pharmacological treatment will generally be necessary.
Unlike benzodiazepines, Buspirone, a serotonergic azapirone anxiolytic, does not generally produce as many undesirable effects. It is often used as an alternative, as it produces little or no sedation and fewer potential drug interactions. Depending on other symptoms, such as hallucinations or aggression, medical interventions will be based on one’s personal needs.
Overall, treating anxiety and other behavioral symptoms among Alzheimer’s patients is difficult and complex. Although adverse effects can occur, when doses are controlled and used short-term, medications can improve quality of life for both the patient and caregiver. Regardless of one’s needs, a biopsychosocial approach is typically best.