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Managing Anxiety in People With Dementia A Case Series: Brief Report
Managing Anxiety in People With Dementia A Case Series: Brief Report
Managing Anxiety in People With Dementia A Case Series: Brief Report
Brief report
Received 16 October 2001; received in revised form 11 February 2002; accepted 15 February 2002
Abstract
Anxiety is common in people with dementia but little is known about its treatment. Seven cases with moderate / severe
dementia and significant clinical anxiety are described. Anxiety symptoms were measured using the RAID scale. Anxiety
was managed with pharmacological and psychosocial interventions. All patients showed a significant clinical improvement in
their anxiety and had a considerable reduction in their RAID scores. Assessment and effective treatment of anxiety in
dementia should improve patient’s quality of life and should become more established in good clinical practice. Further
research should include a randomised controlled trial of interventions to reduce anxiety.
2003 Elsevier B.V. All rights reserved.
0165-0327 / 03 / $ – see front matter 2003 Elsevier B.V. All rights reserved.
doi:10.1016/S0165-0327(02)00074-5
262 A. Qazi et al. / Journal of Affective Disorders 76 (2003) 261–265
2 78 M Alzheimer’s Aggressive behaviour, 15/4 12/5 Lofepramine Calm and cooperative, Discharged to residential
disease restlessness, agitation, 140 mg bd not aggressive, sleeping home
6 poor sleep all night, bright and cheerful
3 78 F Alzheimer’s Persistent restlessness, 12/4 11/6 Sertraline Calm and settled, Discharged to EMI unit
disease agitation, disinhibited 100 mg cooperative, not disinhibited,
12 behaviour, wandering good sleep and appetite
up and down the ward
4 82 M Vascular Restlessness, agitation, 24/8 16/6 Fluoxetine Pleasant and cooperative, Discharged home
dementia aggressive towards staff 20 mg sleeping well, not aggressive
12
5 76 F Alzheimer’s Poor sleep, poor appetite, 14/3 12/4 Sertraline Good sleep and appetite, Discharged to a
disease withdrawn and apathetic 100 mg more communicative, taking residential home
18 at times, restless at others interest in things doing
small chores on the ward
6 79 F Vascular Wandering, abusive and 22/12 Scale Paroxetine Not wandering, less anxious Discharged to nursing
dementia aggressive behaviour, not 20 mg and distressed, good sleep, home
disturbed sleep/wake cycle used attending OT
7 76 M Dementia Irritability, pacing round 36/25 Scale Psychosocial Not as irritable, not wandering, Died in hospital
unspecified the house, wandering, not intervention more manageable in the ward due to
sleep disturbance used bronchopneumonia
263
264 A. Qazi et al. / Journal of Affective Disorders 76 (2003) 261–265
presented with sleep disturbance, was repeatedly study, Shankar et al., 1999 reported that when these
asking for reassurance from his wife and was common items were removed from the RAID scale it
constantly complaining of headaches. He had epi- correlated poorly with the Cornell scale. This sug-
sodes of irritability with pacing around the house and gests that the RAID scale has items specific for
on occasions walked out of his home and had to be anxiety.
brought back by police. All these led to his admis- There are no controlled studies that have spe-
sion to hospital. There he was able to wander within cifically looked into the management of anxiety in
the ward. He was given his own room instead of a dementia patients. Koder (1998) reported two case
dormitory, which gave him a sense of personal reports in which cognitive behavioural therapy was
space. He was also given some night-time sedation. used. The techniques used were relaxation, distrac-
The real breakthrough came when his wife presented tion and cognitive restructuring. Nyth and Gottfries
him with an electronic keyboard. He started to play (1990) reported the efficacy of citalopram in emo-
the tunes which he had learnt in the past. His tional disorders inpatients with Alzheimer’s disease
behaviour improved and he became more manage- and vascular dementia. The efficacy of cholinesterase
able on the ward. His RAID scale decreased by 9 inhibitor drugs in improving anxiety as measured by
points within a week (Table 1). the Neuropsychiatric Inventory (Cummings et al.,
1994) has also been reported.
The case reports show a clear temporal relation-
4. Discussion ship between treatment of anxiety and improvement
in clinical presentation and outcome with decreased
This case series highlights the fact that anxiety RAID and Cornell scores. This paper indicates that
symptoms in dementia patients are identifiable, anxiety in dementia is treatable and thus highlights
measurable and can be treated. The patients re- the need for a well designed randomised control trial
sponded to a range of interventions. Being in a to identify and treat anxiety in dementia sufferers.
hospital environment with specialised experienced
staff could in itself have had some therapeutic effect.
Patients in this case series also responded to their Acknowledgements
own specific environmental needs for example a
secure ward environment, presence of their own We thank the nursing staff on the wards for
space (private room), a place to wander and walk, administering the scales to the patients. We also
and presence of others (patients, staff). The medica- thank Terri for her help and support.
tion used varied with the individual patient’s needs
but usually involved antidepressants.
The overlap between anxiety and depressive References
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