Late Stage Symptom: Anxiety & Depression

As Alzheimer’s disease progresses, symptoms change and tend to become more pronounced at each stage, particularly the behavioral symptoms. While the physical and cognitive changes can be difficult, the behavioral symptoms can bring their own challenges. Although there are treatments and strategies to help manage behavioral symptoms, there is no cure for Alzheimer’s disease, and no treatment will fully stop the symptoms or slow down its progression. It can be helpful to remember, then, that the aim of these treatments is to help mitigate symptoms, along with various strategies and lifestyle adaptations to help maintain quality of life and minimize the impact of Alzheimer’s disease.

Anxiety and depression can occur at any stage of Alzheimer’s disease, although the severity can vary, depending on the stage. There are multiple treatments available for anxiety and depression, both non-drug and medications, and these can be very effective. These treatments can ease or minimize the feelings of depression and anxiety, but will not slow down the progression of Alzheimer’s disease. Left untreated, both anxiety and depression can significantly impact quality of life, as well as health.

Anxiety

Anxiety can be caused by a variety of things, including medical conditions or medication interactions, so it’s always a good idea to see a doctor to rule out any other possible cause for the anxiety. In Alzheimer’s disease, the individual experiences the loss of the ability to negotiate and process new information, which can cause anxiety or agitation.¹ In the beginning of the disease, there could be anxiety about the future: what to expect, how things will change, and anxiety about the disease itself. As the disease progresses, anxiety can be triggered by a variety of things. Outside catalysts for anxiety can also include any changes to the usual routine, a new residence or caregiver, confusion, fear, or fatigue.

Depression

Depression is common in people with Alzheimer’s disease, particularly in the early and middle stages of the disease.⁴ Symptoms of depression can overlap those of Alzheimer’s, so it’s not always easy to diagnose depression. If depression is suspected in a person with Alzheimer’s, they should see a doctor to discuss how they’re feeling and any symptoms they might be experiencing. The doctor should also do a medical exam to rule out any other causes of their symptoms – a geriatric psychiatrist can be especially helpful in this regard.⁴

Non-medication treatments

Although there are anti-anxiety medications, non-drug strategies should be used first. This includes¹:

• Creating a calm environment and providing a security object, lots of rest, and privacy
• Simplifying tasks or routines
• Physical exercise
• Check in with the person about toileting needs, pain, hunger, thirst, and any other requests
• Cognitive behavioral therapy
• Progressive muscle relaxation
• Meditation
• Increased social interactions
• Preventing overstimulation

If non-drug strategies don’t work, talk with the doctor about medications to help relieve anxiety. Both anti-anxiety and antidepressants can help address anxiety, and the doctor will work with the patient and family or caregiver to determine the most appropriate medication for the patient.^2,3 Selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (SSRIs, SNRIs) are often used in those with Alzheimer’s disease because of their low likelihood of interaction with other drugs.⁴ No matter what medication the person is on, talk with the doctor about any possible side effects and interactions. Even on medication, the person should get interpersonal support from family, friends, and caregivers, as well as other professionals. Some of these medications can increase cognitive impairments, so it is important to see a doctor who specializes in memory disorders to determine the best medication.

Anxiety and depression are common behavioral symptoms in Alzheimer’s disease, but don’t have to have a negative impact on quality of life. There are treatments to address these symptoms, and the earlier treatment starts, the sooner the patient can feel relief and improved quality of life.