Anxiety in Dementia: Signs, Causes and How to Help

Worry, restlessness, pacing and clinging to a caregiver are common in dementia; here's how anxiety shows up, what often triggers it, and calm, practical ways families can help.

By Jim Pavlish, Editor · Last updated: October 25, 2026 · Editorial policy

Anxiety is one of the most common emotional changes in dementia. It can start early, sometimes before a diagnosis, when a person senses that something is wrong with their memory. Later, it often comes from a world that feels confusing and unpredictable. Understanding where it comes from makes it much easier to help.

This page is general information. If anxiety is new, severe, or getting worse, talk with the person's doctor, because it can have medical causes that need treatment.

How anxiety can look in dementia

A person may not say "I feel anxious." Instead you might notice:

• Asking the same worried question again and again (see Repetitive Questions and Behaviors)
• Pacing, fidgeting, wringing hands or not being able to sit still
• Following a caregiver from room to room, or becoming upset when that person leaves ("shadowing")
• Worrying about money, appointments or being late, even when there's nothing scheduled
• Trouble falling asleep, or being more unsettled in the late afternoon (see Sundowning)
• Irritability, snapping or, at times, agitation (see Agitation and Aggression)
• Physical complaints such as stomachaches or feeling short of breath

Common causes and triggers

The illness itself. Dementia changes the parts of the brain that help us make sense of what's happening and calm ourselves down.

Feeling lost. Not recognizing a place, a face or the time of day is frightening. New surroundings, a move, a hospital stay or travel can all raise anxiety (see Hospital Stays and Dementia).

Too much going on. Noise, crowds, a busy TV or several people talking at once can overwhelm.

Body discomfort. Pain, constipation, hunger, thirst, being too hot or cold, or needing the toilet can show up as anxiety in someone who can't explain how they feel (see Recognizing Pain in Dementia).

Illness and medicines. Infections such as a urinary tract infection, poor sleep, and side effects or interactions of medicines can all play a role. Sudden changes should always be checked by a doctor, since they can be a sign of delirium.

Picking up on others' stress. People with dementia are often very sensitive to the moods around them. A tense caregiver can, without meaning to, make the person more anxious.

Ways to help in the moment

• Stay calm and close. Speak slowly and softly, get down to eye level, and offer a gentle touch if they welcome it.
• Respond to the feeling, not the facts. "You seem worried. I'm right here, and we'll take care of it together." Arguing about whether the worry is real rarely helps.
• Keep it simple. Offer one clear answer or one choice at a time.
• Redirect gently. After reassuring, move to something soothing: a snack, a walk, a favorite song, folding laundry.
• Reduce the noise. Turn off the TV, move to a quieter room, or step outside for a few minutes.
• Check basic needs. Ask yourself: Could they be hungry, thirsty, in pain, tired or needing the bathroom?

Ways to lower anxiety over time

• Predictable routines. Doing things at the same time and in the same order each day helps the world feel safer (see Daily Care and Routines).
• Visual cues. A large-print calendar or a whiteboard with "Today is Monday. Lunch with Sam at noon" can answer worries before they start (see Memory Aids and Tools).
• Don't announce events too early. For some people, hearing about an appointment days ahead brings days of worry. Mention it closer to the time.
• Daily movement and daylight. Walks and time outdoors can help with mood and sleep (see Staying Active and Engaged).
• Music and meaningful activity. Familiar music, simple hobbies and helpful tasks can be calming (see Music and Art Therapy and Activities for People with Dementia).
• Limit caffeine, especially later in the day.
• Plan for separations. If the person gets upset when you leave, a trusted friend or an adult day program can help them get used to time with others.

When to talk to the doctor

Contact the person's doctor if anxiety is new or sudden, is getting worse, keeps the person from sleeping or eating, leads to aggression, or comes with signs of depression such as sadness, withdrawal or loss of interest. Anxiety and depression often occur together in older adults and both can be treated.

Doctors generally recommend trying non-drug approaches first (see Non-Drug Treatments for Dementia). Sometimes medicine is appropriate, but certain drugs used for anxiety and sleep can increase confusion and fall risk in older adults, so any medicine should be chosen and reviewed by the prescriber (see Treating Behavioral Symptoms and Medications That Can Affect Memory).

Look after your own stress too

Living with someone's constant worry is draining. Breaks, support groups and respite care are not luxuries (see Caregiver Stress and Burnout and Respite Care). The Alzheimer's Association's free 24/7 Helpline at 800-272-3900 can talk through specific situations.

Sources

1. Alzheimer's Association: Anxiety and Agitation
2. Alzheimer's Association: Communication and Alzheimer's
3. National Institute on Aging: Depression and Older Adults
4. National Institute on Aging: Communicating With Someone Who Has Alzheimer's Disease

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Agitation and Aggression
• Sundowning
• Personality and Mood Changes
• Repetitive Questions and Behaviors
• Treating Behavioral Symptoms