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    Dementia Symptoms & Caregiver Strategies: Anxiety and Cognitive Impairment

    A person with cognitive impairment may feel anxious or agitated. He or she may become restless, causing a need to move around or pace, or become upset in certain places or when focused on specific details.

    Possible causes of anxiety
    Anxiety and agitation may be caused by a number of different medical conditions, medication interactions or by any circumstances that worsen the person's ability to think. Ultimately, the person with cognitive challenges is experiencing a profound loss of their ability to process information. It is a direct result of frustration of not being able to do what used to come easily.
    Situations that may lead to agitation include:

    • Moving to a new residence or nursing home
    • Changes in environment, such as travel, hospitalization or the presence of houseguests
    • Changes in caregiver arrangements
    • Misperceived threats
    • Fear and fatigue resulting from trying to make sense out of a confusing world

    Treating Behavioral Symptoms
    Anyone experiencing behavioral symptoms should receive a thorough medical checkup, especially when symptoms appear suddenly. Treatment depends on a careful diagnosis, determining possible causes and the types of behavior the person is experiencing. With proper treatment and intervention, symptoms of agitation can be reduced.

    Tips to prevent or reduce anxiety:
    • Create a calm environment.
      Remove stressors. This may involve moving the person to a safer or quieter place, or offering a security object, rest or privacy. Try soothing rituals and limiting caffeine use. Playing calming music in the background can also help.
    • Avoid environmental triggers.
      Noise, glare and background distraction (such as having the television on) can act as triggers.
    • Monitor personal comfort.
      Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Make sure the room is at a comfortable temperature. Be sensitive to fears, misperceived threats and frustration with expressing what is wanted.
    • Simplify tasks and routines.
    • Provide an opportunity for exercise.
      Go for a walk. Garden together. Put on soothing music. Dance.

    How to respond
    Do: Back off and ask permission; use calm, positive statements; reassure; slow down; add light; offer guided choices between two options; focus on pleasant events; offer simple exercise options, try to limit stimulation.

    Say: “May I help you?” “Do you have time to help me?” “You're safe here.” “Everything is under control.” “I apologize. I'm sorry that you are upset. I know it's hard. I will stay with you until you feel better.”
    • Listen to the frustration.
      Find out what may be causing the agitation, and try to understand.
    • Provide reassurance.
      Use calming phrases such as: "You're safe here;" "I'm sorry that you are upset;" and "I will stay until you feel better." Let the person know you are there.
    • Involve the person in activities.
      Try using art, music or other activities to help engage the person and divert attention away from the anxiety.
    • Modify the environment.
      Decrease noise and distractions, or relocate.
    • Find outlets for the person's energy.
      The person may be looking for something to do. Take a walk or go for a car ride.
    • Check yourself.
      Do not raise your voice, show alarm or offense, or corner, crowd, restrain, criticize, ignore or argue with the person. Take care not to make sudden movements out of the person's view.
    • See their doctor.
      See the person's primary care physician to rule out any physical causes or medication-related side effects.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: