Alzheimer's Club

MIAMI, FL - Clinicians who assess patients with Alzheimer's disease are failing to recognize their symptoms of anxiety, mistaking them instead for agitation, researchers said in a presentation here at the 26th Annual Conference of the Anxiety Disorders Association of America (ADAA).

"Anxiety in Alzheimer's disease right now is not being picked up and current assessment tools may be mistaking anxiety for agitation," said presenter Maria S. Almeida, MD, resident psychiatrist, University of Nebraska Medical Center, Omaha, Nebraska.

Tools being used to assess patients with Alzheimer's disease focus on a very limited set of anxious behaviors, she said. "We suggest looking at anxiety in different ways," Dr. Almeida said during the meeting's New Research poster session.

Anxiety in Alzheimer's disease patients can be provoked in ways that are unique to the disease. Earlier research by Gene D. Cohen, MD, PhD, Professor of Psychiatry and Director, Center on Aging, Health & Humanities at George Washington University in Washington, DC, suggests that anxiety in this population has the following precipitants:

· challenging situations or performance demands;
· changes in the patient's environment;
· lack of engagement with people or the environment;
· settings that lack structure.

To determine whether the currently used assessment tool -- the Neuropsychiatric Inventory (NPI) -- is relevant to Dr. Cohen's model of anxiety, Dr. Almeida and her colleagues analysed the anxiety subsection of the inventory. The NPI is often used for assessment of psychopathology in patients with dementia and other neuropsychiatric disorders.

Their analysis found that the NPI emphasized the somatic and cognitive components of Alzheimer's disease, but did not adequately assess the behavioral aspects of anxiety associated with the disease.

"The NPI has a screening question for anxiety, and if the answer to that question is a no, then we tend not to go ahead and ask further questions, and so we end up missing the real signs and symptoms of anxiety in Alzheimer's," she said.

"What we recommend is -- irrespective of the answer to that screener question, whether it be yes or no -- to go ahead and ask other questions, and perhaps we will enhance our ability to pick up on the anxiety component," she added. "If we understand it better, then maybe we could treat it better."

[Presentation title: Lack of Recognition of Anxiety in Alzheimer's Disease.]

Source: Fran Lowry. Anxiety in Alzheimer's Disease Patients is Not Being Recognized: Presented at ADAA. Peer Review Media Bar (28 March 2006) [FullText]