Reluctance and fear from being separated from a primary caregiver, or separation anxiety, is a normal, healthy response and occurs regularly in those with Alzheimer's disease or dementia.

Many factors contribute to separation anxiety, including changes in a caregiver or household routine, illness or from just being tired and/or over stimulated.

For the person affected by Alzheimer's or dementia, separation anxiety can be magnified as they already feel personally "lost," and losing, or being separated from, a familiar caregiver can make them unsettled and agitated. The thought of being alone, or even abandoned, greatly affects them and can be challenging for the primary caregiver.

Some caregivers find their loved ones "shadow them," meaning they are constantly underfoot, so to speak. They are not doing it on purpose. The disease can make the affected person act in such a way that he or she needs that familiar person, who becomes the center of his or her world. It's a form of reassurance and validity, a connection relied upon for security. Without it, the affected person soon becomes paranoid and afraid, and their anxiety can produce behavioral outbursts or expressions.

One idea for managing separation anxiety is to get the affected person to build trust in others so the primary caregiver can have some respite. Trusted caregivers can be family or close friends or even a consistent professional paid caregiver. Once trust is established, it will be easier for the caregiver to get away when needed.

Redirecting the affected person is another way to reduce separation anxiety. Validate their fear and anxiety and use a comforting and soothing tone of voice for reassurance. Then direct them toward what they enjoy doing, such as taking a walk outside, working on a puzzle, gardening, painting, looking at photographs or listening to favorite music.

Pay attention to routine. More structure in the day means less chance anxiety will rise. Offer the affected person understanding and acceptance and never scold or ridicule them for the way he or she is feeling or acting.

The environment also can cause anxiety to escalate. If surroundings are frequently changed, this can be disorienting for the affected person and cause stress.

Additionally, if the caregiver is feeling stress, the affected individual may feel it, too. If he or she senses a caregiver's frustration or distress when leaving, that might signal to them that something is wrong and escalate the situation and the anxiety.

Questions about Alzheimer's disease or related disorders can be sent to Dana Territo, the Memory Whisperer, owner of Dana Territo Consulting, LLC, at