When someone is diagnosed with dementia, it is natural to experience a range of emotions. For some people, this develops into persistent depression or anxiety – and it is important that they get support.
People with dementia may have difficulty expressing that they are feeling anxious or depressed. However, there may be clues in their behaviour, for example:
pacing or fidgeting
needing constant reassurance
‘sundowning’: a state of intense confusion and anxiety in the evening
sleep changes, eg waking early or sleeping more
changes in appetite
Because of the similarity in symptoms, dementia is sometimes misdiagnosed as anxiety or depression, which may delay an accurate diagnosis.
This can be a particular issue for people who develop dementia symptoms before the age of 65 (known as young onset dementia), as some healthcare professionals lack awareness of dementia in younger people and how it presents.
Similarly, depression or anxiety may be overlooked in a person with dementia as the symptoms may be put down to their dementia.
Depression-related psychosis may also be missed, as symptoms such as hallucinations and delusions may occur in dementia – particularly Lewy body dementia.
If low mood or anxiety are affecting someone’s daily life, it is important that they seek help.
If possible, support the person to take a self-assessment quiz first – please see Sources of support for details of the NHS test for depression.
It is also useful to keep a symptom diary – family members and friends could contribute to this too.
The GP should ask the person about their symptoms and:
how they are affecting them mentally and physically
how long they have had them
how often they are experiencing them
if there are any triggers for these feelings
whether there is a family history of anxiety or depression
It is helpful for a family member or friend to go to the GP with the person to offer support and provide information about any changes they have noticed.
A GP can usually make a diagnosis of anxiety or depression based on what the person tells them. They may also take blood tests to rule out conditions with similar symptoms, such as thyroid problems or vitamin deficiency.
For many people, the symptoms of mild to moderate anxiety or depression can be eased without medical treatment. The following may help:
a healthy, balanced diet
talking therapy, eg cognitive behavioural therapy (CBT) or counselling
alternative therapies, eg acupuncture, reflexology or herbal remedies
Generally, these strategies are more effective in the early to middle stages of dementia – people in the later stages may find it hard to engage with them.
In some cases – for example, if the strategies above have not helped or the person’s anxiety or depression are more severe – medication such as antidepressants may help. These may also be prescribed for the symptoms of frontotemporal dementia.
If you support a person with dementia who is experiencing anxiety and/or depression, these tips might help:
Support the person to exercise. If they like to run or cycle but are vulnerable if they go out alone, consider whether you or someone else could go with them. If they have mobility problems, they may be able to do chair-based exercises. Everyday tasks like housework and gardening also count
Encourage them to limit alcohol, which can lower mood, and caffeine, which can affect sleep
Help the person plan, prepare and eat healthy meals
Look into mental health or dementia support groups, in person or online
Support the person to take any medication as prescribed – pill organisers, wall charts or reminders on their phone can be useful
Talk to them about how they are feeling and what you can do to help
Encourage good sleep habits – see Sources of support, below, for advice
Tell family and friends (with the person’s permission) that they are experiencing anxiety/depression so they can offer support
Support them to engage in activities that they usually enjoy, like exercise, gardening, craft, singing, dancing and volunteering
Spend time reminiscing and sharing photos, memories, favourite music, films or books
Ask their GP about talking therapies – although these may be harder for the person to engage in as dementia progresses
Try introducing a doll or soft toy that the person can ‘care for’ – this may make them feel more purposeful and less isolated
If the person is experiencing suicidal thoughts, contact their GP as soon as possible. In an emergency, take them to A&E or call an ambulance
To speak to a dementia specialist Admiral Nurse about depression, anxiety or any other aspect of dementia, call our free Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December) or email email@example.com.