The connection between dementia and anxiety | Elaine Eshbaugh | TEDxUniversity of Northern Iowa

Key Concepts

• Anxiety & Cognition: Inverse relationship – as anxiety increases, cognitive function decreases. This is particularly impactful for individuals with dementia.
• Dementia & Reality: Dementia alters brain function, potentially creating a personal reality that differs from shared reality, but both are equally valid to the individual.
• Mental Energy Pennies: A metaphor for the limited cognitive resources available to everyone, especially those with dementia, depleted by tasks and stressors.
• Environmental & Interaction Modifications: Strategies to reduce anxiety and support cognitive function in individuals with dementia by altering the environment and communication style.
• Vision Impairments in Dementia: Dementia impacts visual processing, including peripheral vision, depth perception, and image fusion, leading to potential difficulties with mobility and object recognition.
• Empathy & Empowerment: Shifting the focus from correcting symptoms to understanding and supporting individuals with dementia to live fulfilling lives.

Understanding Anxiety and Dementia: A Deep Dive

This presentation explores the complex relationship between anxiety and dementia, emphasizing the importance of understanding how individuals with dementia experience the world and how caregivers can best support them. The core argument is that anxiety significantly impacts cognitive function, and this impact is amplified in individuals living with dementia.

The Anxiety-Cognition Connection

The speaker begins by establishing a fundamental principle: when anxiety goes up, cognition goes down. This is universally true, but critically important for understanding dementia. Anxiety manifests in various ways – racing thoughts, increased heart rate, nausea, sweating – and these physiological responses directly impede cognitive processes. The presenter illustrates this with the example of taking an important test; even with preparation, anxiety can hinder performance.

Dementia: Beyond Memory Loss

Contrary to common perception, dementia is not solely about memory loss. It’s a broad condition impacting all brain-controlled functions: movement, mood, personality, perception, speech, sensation, and crucially, anxiety. Dementia can cause increased anxiety, as navigating a confusing world can be inherently frightening.

The speaker highlights the distinction between anxiety rooted in shared reality (e.g., a tornado watch) and anxiety stemming from an individual’s unique reality (e.g., believing a tornado is coming when there isn’t one). However, she stresses that this distinction is less important than recognizing the validity of the individual’s experience. “Their reality is just as real to them as your reality is to you.”

The Exhaustion of Anxiety & Mental Energy Pennies

Anxiety is exhausting because the brain is constantly scanning for potential threats, running “what if” scenarios. This constant vigilance consumes cognitive resources. The speaker introduces the concept of “mental energy pennies” – a daily allotment of cognitive resources (comprehension, emotional stability, patience) that are depleted by any brain-intensive activity.

A crucial point is made: individuals with dementia often start with a significantly lower “penny” count (50, 20, or even 10 compared to a typical 100), and everything requires more energy. Furthermore, caregivers can inadvertently “steal” these pennies through interactions that increase anxiety.

The Cost of Questioning Reality

The speaker provides a compelling example of how seemingly innocuous questions can deplete mental energy. Asking “Grandma, do you know who I am?” implies a failure to recognize, increasing anxiety and making recognition less likely. Instead, a simple, affirming statement like “Hey, Grandma, it’s me, your granddaughter, Elaine” is far more effective, avoiding the cognitive strain of a “pop quiz.”

Perception & Sensory Processing in Dementia

The presentation delves into how dementia alters perception, specifically focusing on auditory and visual processing. Individuals with dementia may struggle to prioritize sounds, experiencing a cacophony of stimuli similar to trying to follow multiple conversations at a crowded event. This constant sensory overload depletes mental energy.

A friend with dementia articulated this experience, explaining that the ticking of a clock interfered with his ability to focus on a conversation, demonstrating how seemingly insignificant environmental factors can be profoundly disruptive.

Visual Impairments: A Hidden Challenge

Dementia significantly impacts vision, often in ways that are not readily apparent. The speaker demonstrates how simulating peripheral vision loss (using hand circles around the eyes) can mimic the visual experience of someone with dementia, potentially explaining seemingly illogical movements or difficulties with balance.

She further explains how dementia can disrupt the brain’s ability to fuse images from both eyes, leading to double vision or depth perception problems. The key takeaway is that visual difficulties are often a result of brain dysfunction, not simply a need for glasses. A person with dementia might repeatedly clean their glasses or claim someone has altered their lenses, not because of an eye problem, but because of the brain’s inability to process visual information correctly.

Strategies for Support: Changing Interactions & Environments

The speaker outlines three key strategies for supporting individuals with dementia:

1. Acceptance: You cannot change or fix the dementia brain.
2. Interaction Modification: Change how you interact with the person. This includes avoiding questions that challenge their reality and offering simple, affirming statements.
3. Environmental Modification: Change the environment to minimize distractions. This could involve turning off the TV, reducing noise levels, or ensuring adequate lighting.

Shifting the Paradigm: Empathy and Empowerment

The presentation concludes with a powerful call for empathy and a shift in perspective. The speaker argues that we should not get angry at individuals with dementia for their symptoms, just as we wouldn’t get angry at someone with lung cancer for coughing.

She draws a vivid analogy, imagining the anxiety and fear of being subjected to unwanted physical contact or having one’s clothing removed by a stranger – experiences that some individuals with dementia may endure.

Despite the challenges, the speaker emphasizes that many individuals with dementia continue to live fulfilling lives, even pursuing activities like work, travel, and marathon running. The ultimate goal is to empower those living with dementia to live their best possible lives, recognizing that when anxiety goes down, cognition, connection, engagement, and a sense of purpose go up.

This presentation advocates for a more compassionate and understanding approach to dementia care, focusing on creating supportive environments and interactions that prioritize the individual’s experience and well-being.