Dementia and Anxiety: Signs, Triggers and What Helps

Dementia and anxiety very often go together: studies put anxiety symptoms at anywhere from 8 to 71 percent of people with dementia, and WebMD says up to 3 in 4 people with Alzheimer’s may have some anxiety. It often shows as pacing, repeated questions, following you from room to room or panic about being alone, and it tends to be worse in the late afternoon and at night. Most of it eases with calm reassurance, a steady routine and a check for hidden causes such as pain, hunger or a new medicine, so tell your parent’s doctor about any new or sudden change.

This guide covers what dementia-related anxiety looks like, what sets it off, how to calm a moment of panic, what helps day to day, and when to call the doctor. It describes; it does not diagnose. Your parent’s doctor decides on any treatment.

How common is anxiety in dementia?

Figures vary with how anxiety is measured, but every source we checked agrees it is common:

• 8 to 71 percent of people with dementia have anxiety symptoms, and 5 to 21 percent have an anxiety disorder, according to a 2017 review in Dementia and Neurocognitive Disorders.
• Up to 3 in 4 people with Alzheimer’s may have some anxiety, WebMD reports.
• It varies by type. The Alzheimer’s Society says anxiety is particularly common in vascular dementia and frontotemporal dementia, and less common in Alzheimer’s. The 2017 review adds Parkinson’s disease dementia.
• It changes with the stage. The Alzheimer’s Society says anxiety seems more common in people who still have good insight. The 2017 review found it declines in the severe stage.

Why does it happen? The Alzheimer’s Society points to damage in the parts of the brain involved in emotion, along with stress, pain, exhaustion and medicine side effects. Early on, anxiety is often about coping with the diagnosis. Later, it tends to come from confusion, such as worrying about children who are long grown.

What anxiety looks like in dementia

Your parent may not be able to say “I’m anxious.” WebMD notes that people with Alzheimer’s may have trouble saying how they feel. Signs to watch for, drawn from the Alzheimer’s Society, WebMD and the 2017 review:

• Pacing and fidgeting. Walking the same loop, wringing hands, unable to settle.
• Repeated questions. “When are we leaving?” over and over, because the worry stays when the answer is forgotten. See our guide to repetitive questions in dementia.
• Shadowing. Following you from room to room, which the Alzheimer’s Society links to fear of being alone. Our page on shadowing in dementia goes further.
• Fear of being alone. Repeated phone calls to family, or panic when you leave the room.
• Panic. A racing heart, shortness of breath, dizziness or nausea.
• Irritability, picking and hoarding. Snapping at small things, scratching skin, or hiding things.
• Poor sleep. Waking at night, or getting up to “go home.”

Anxiety in the late afternoon and at night

Many families notice that anxiety builds as the day ends. The Alzheimer’s Association describes sundowning as increased confusion from dusk through the night, with anxiety, agitation, pacing and trouble sleeping. Possible causes include exhaustion, a mixed-up body clock, low light that creates shadows, and dreams that blur with reality. Our guide to sundowning and dementia covers the evening pattern in detail.

Common triggers

WebMD suggests looking at what happened just before the anxiety appeared. Common triggers, from WebMD, the Alzheimer’s Association and the Alzheimer’s Society:

• Change. A move, a hospital stay, houseguests, a new caregiver or a new schedule.
• Noise. A loud TV, crowds, glare.
• Pain. Arthritis, a toothache or constipation they cannot describe.
• Hunger, thirst, temperature and toileting. Too hot, too cold, or a full bladder.
• Too much or too little to do. Being rushed, or long empty hours.
• Unfamiliar people and places, and confusion over misplaced items.
• Caffeine and alcohol.
• Your stress. WebMD and the Alzheimer’s Association both say a person with dementia can react to a caregiver’s emotions.

What helps in the moment: a calm-down approach

The goal is to help your parent feel safe, not to win an argument about the facts. This approach follows the Alzheimer’s Association’s advice on anxiety and agitation, with tips from WebMD and UF Health:

1. Check yourself first. Slow your breathing and lower your voice. The Alzheimer’s Association says not to raise your voice or show alarm, and not to corner, restrain, criticize or argue.
2. Listen and name the feeling. “You’re worried about Dad.” Take the worry seriously even when it does not match reality.
3. Reassure in a few words. The Alzheimer’s Association suggests “You’re safe here” and “I will stay with you until you feel better.” Use short, simple sentences.
4. Check for a physical need. A drink, a snack, the bathroom, a blanket, or pain.
5. Lower the noise. Turn off the TV, and turn on more lights if it is getting dark.
6. Redirect gently. Offer a walk, a car ride, a favorite song or a simple task such as folding towels.
7. Offer touch only if it is welcome.
8. If it is not working, give space. WebMD advises stepping back, as long as they are safe.
9. Write down what happened: the time, what came just before, and what helped.

WebMD notes that something may work one day and not the next. That is normal; keep a few options ready.

What helps day to day

These ideas come from the Alzheimer’s Association, the Alzheimer’s Society, WebMD and UF Health:

• A predictable routine. Keep meals, walks and bedtime at the same times, and plan appointments and bathing for the morning.
• The right amount of activity. Plan simple, familiar activities, since starting them alone is often hard, and allow rest.
• Light. Get daylight in the morning and keep the home well lit in the evening. UF Health says to keep night lighting low but not so low that there are shadows.
• Exercise. The Alzheimer’s Society says regular physical activity can reduce anxiety and help sleep. In Florida, a morning walk avoids the worst heat; bring water.
• Music. The Alzheimer’s Society links music therapy with reduced agitation; favorite songs at home are an easy start.
• A calm evening. Decaf after lunch, a lighter supper, quiet activities after dark and a familiar bedtime routine.
• One consistent companion. Changes in caregivers are a known trigger. A familiar face can head off worry before it builds.
• Familiar things. Photos or a favorite blanket can comfort, especially in a new place.

Anxiety, agitation or depression? A comparison

These three often overlap, and the 2017 review notes that restlessness, tiredness and poor concentration can come from dementia itself, so they are hard to tell apart. A rough guide to what you might see:

A person can have all three, and WebMD says anxiety is often behind behaviors such as wandering and aggression. The table is a guide for what to tell the doctor, not a way to diagnose. If low mood or loss of interest is the bigger picture, see our guide to dementia and depression.

When to call the doctor

The Alzheimer’s Association says anyone with behavior changes should have a thorough medical checkup, especially when symptoms appear suddenly. Call your parent’s doctor if:

• The change is sudden. If your parent became much more anxious, confused, drowsy or agitated over hours or days, think of delirium, which often has a treatable cause such as an infection. See our page on delirium in dementia.
• Pain might be behind it.
• A medicine changed. The Alzheimer’s Society lists medicine side effects, and stopping a medicine too quickly, as causes of anxiety. UF Health says to call if you think medicines may be causing behavior changes.
• Sleep or toileting changed. The Alzheimer’s Association notes that urinary tract infections and sleep apnea can worsen night problems.
• Your calm-down steps stop working.

Bring your notes and a full list of medicines, including over-the-counter ones and supplements.

Treatment is the doctor’s decision. The Alzheimer’s Association says non-drug approaches are recommended first. The Alzheimer’s Society says talking therapies such as CBT, adapted for memory problems, can help in the early to middle stages, and that some people are prescribed medicine. WebMD notes that anxiety medicines often do not work as well for older people, and the Alzheimer’s Association says the risks and benefits of any medicine should be discussed with the doctor. Never start, stop or change a medicine, including store-bought sleep aids, without the doctor.

Caregiver anxiety too

Being followed all day and lying awake listening for footsteps wears anyone down, and a tense caregiver can unsettle the person with dementia. Experts quoted by the Women’s Brain Health Initiative put it plainly: no one should do this alone.

See your own doctor if you are not sleeping or feel constantly on edge. Take regular breaks, accept offers of help, and join a caregiver support group. Our guide to self-care for dementia caregivers has practical ideas.

Urgent signs: when to get help now

• Call 911 if your parent or anyone else is in danger, has been hurt, or has chest pain or severe trouble breathing. UF Health says to call 911 if you or the person with dementia is in danger.
• Call or text 988 (the 988 Suicide & Crisis Lifeline) if your parent talks about ending their life, or if you are in crisis yourself. It is free and confidential and answers any time, day or night. You can also chat at 988lifeline.org.
• Call the doctor the same day for sudden confusion, a fever, or a fall.

A first panic attack can look like a heart problem. If you are not sure, call 911.

Florida help for anxiety and dementia

• Memory Disorder Clinics. Florida’s Alzheimer’s Disease Initiative funds 17 Memory Disorder Clinics across 13 service areas, offering diagnostic and referral services for Alzheimer’s and related dementias.
• Elder Helpline, 1-800-963-5337. The Department of Elder Affairs’ line gives information on elder services and activities in every Florida county.
• Aging and Disability Resource Centers. Florida’s 11 Area Agencies on Aging work as ADRCs. In our areas: Area Agency on Aging for Southwest Florida, (239) 652-6900; Area Agency on Aging of Palm Beach/Treasure Coast, (561) 684-5885; Alliance for Aging in Miami, (305) 670-6500. Ask about the Alzheimer’s Disease Initiative’s caregiver counseling, support groups and respite care.

Where our companion care fits

Anxiety in dementia often eases with a familiar face, a steady routine and someone who has time to sit, walk and listen. A consistent companion can keep the day predictable and step in with music, a walk or reassurance before panic builds. Our caregivers are screened for dementia care experience, and you watch each caregiver’s video interview before choosing. We send 3 caregiver video profiles within 48 hours, and your parent has one consistent companion. Our care is non-medical and does not replace the doctor. The rate is $35 an hour · minimum 25 hours a week. No long-term contract. Stop anytime with 7 days’ notice. We serve Southwest Florida, Palm Beach, the Treasure Coast, Miami and the Keys. Call (689) 333-6079 or read about our dementia companion care service.

Sources

• Alzheimer’s Society: Anxiety and Dementia
• Alzheimer’s Association: Anxiety and Agitation
• Alzheimer’s Association: Sleep Issues and Sundowning
• Kwak YT, Yang Y, Koo MS. Anxiety in Dementia. Dementia and Neurocognitive Disorders, 2017
• Santabárbara J, et al. Does Anxiety Increase the Risk of All-Cause Dementia? Journal of Clinical Medicine, 2020
• WebMD: Alzheimer’s Disease and Anxiety
• UF Health: Dementia, Behavior and Sleep Problems
• Women’s Brain Health Initiative: Anxiety Complicates Life for Dementia Patients and Their Caregivers
• 988 Suicide & Crisis Lifeline
• Florida Department of Elder Affairs: Alzheimer’s Disease Initiative
• Florida Department of Elder Affairs: Elder Helpline
• Florida Department of Elder Affairs: Aging and Disability Resource Centers