Anxiety in dementia: A critical review
Section snippets
Search strategy
Initial searches in PubMed and PsycINFO were conducted using the subject words dementia combined with anxiety. In PsychINFO, we also searched the combination of subject words dementia and neuropsychiatry. These two databases were chosen because they are representative of the literature published on this topic and have been used in prior reviews of anxiety in caregivers of individuals with dementia (Cooper, Balamurali, & Livingston, 2007) and anxiety and QoL (Olatunji, Cisler, & Tolin, 2007).
Defining anxiety in dementia
As already noted, the rate of anxiety disorders and symptoms in dementia varies dramatically from study to study, suggesting that there is a lack of consensus about how to define and conceptualize anxiety in this population. Several issues complicate this question, including the distinction between symptoms of anxiety and symptoms of dementia, the overlap between anxiety, depression, and agitation, and what constitutes the best source of information (e.g., patient, caregiver). We now examine
Assessment
Articles describing instruments designed to assess anxiety in dementia, or providing information regarding the reliability and validity of such instruments, were reviewed and included in the present section. Thirteen studies were identified pertaining to four distinct instruments (Auer et al., 1996, Cummings, 1997, Cummings et al., 1994, Fuh et al., 2001, Gibbons et al., 2006, Kang et al., 2004, Kaufer et al., 2000, LaBarge, 1993, Patterson et al., 1990, Reisberg et al., 1996, Reisberg et al.,
Clinical characteristics
In examining the clinical characteristics of anxiety in individuals with dementia, we were guided by three questions. First, what subgroups of individuals with dementia are most likely to present with anxiety symptoms? To answer this question, we specifically examined the roles of demographic characteristics, dementia severity and type, and presence/absence of insight. Second, what is the impact of anxiety on functional outcome and QoL? Third, what are the environmental and social factors
Discussion
The first part of our review focused on conceptual issues: how to define anxiety in this population, how to differentiate symptoms of anxiety from symptoms of dementia, whether anxiety is distinct from agitation and/or depression, and what sources of information should be used when assessing anxiety in individuals with dementia. We found a scarcity of research on these important issues. When designing assessment measures, authors subscribed to underlying assumptions (e.g., by relying solely on
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