Many people find the changes in behavior caused by Alzheimer’s to be the most challenging and distressing effect of the disease. The chief cause of behavioral symptoms is the progressive deterioration of brain cells. However, medication, environmental influences and some medical conditions also can cause symptoms or make them worse.
In early stages, people may experience behavior and personality changes such as:
- In later stages, other symptoms may occur including:
- General emotional distress
- Physical or verbal outbursts
- Restlessness, pacing, shredding paper or tissues
- Hallucinations (seeing, hearing or feeling things that are not really there)
- Delusions (firmly held belief in things that are not true)
- Sleep disturbances
- Non-drug approaches
Non-drug approaches to managingbehavior symptoms promote physical and emotional comfort. Many of these strategies aim to identify and address needs that the person with Alzheimer’s may have difficulty expressing as the disease progresses. Non-drug approaches should always be tried first.
Steps to developing successful non-drug treatments include:
Recognizing that the person is not just “acting mean or ornery,” but is having further symptoms of the disease
Identifying the cause (evaluate their environment)
Changing the environment to resolve challenges and obstacles to comfort, security and ease of mind
Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature.
Avoid being confrontational or arguing about facts. For example, if a person expresses a wish to go visit a parent who died years ago, don’t point out that the parent is dead. Instead, say, “Your mother is a wonderful person. I would like to see her too.”
Redirect the person’s attention. Try to remain flexible, patient and supportive by responding to the emotion, not the behavior.
Create a calm environment. Avoid noise, glare, insecure space and too much background distraction, including television.
Allow adequate rest between stimulating events.
Provide a security object – a doll, a blanket, a stuffed animal
Acknowledge requests, and respond to them.
Look for reasons behind each behavior. Consult a physician to identify any causes related to medications or illness.
Be open to various options – don’t insist that redirecting doesn’t work – every day, every moment, is different in the life of dementia
Don’t take the behavior personally, and share your experiences with others – join a support group, build your support network
Some medications commonly used to treat behavioral and psychiatric symptoms of dementia:
Antidepressants for low mood and irritability:
Anti-anxiety for anxiety, restlessness, verbally disruptive behavior and resistance:
Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness:
What to Expect as the disease progresses:
Alzheimer’s disease takes a different path in every patient. In some people the symptoms worsen quickly, leading to severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer’s is three to nine years. Severe memory loss and confusion within a few years. In others, the changes may be more gradual with the disease taking 20 years to run its course. The average length of survival after a diagnosis of Alzheimer’s is three to nine years.
Because Alzheimer’s affects concentration, patients may lose the ability to manage ordinary tasks like cooking or paying the bills. A study suggests difficulty balancing a checkbook is often one of the first effects of Alzheimer’s. As the symptoms worsen, your loved one may not recognize familiar people or places. He or she may get lost easily, or use utensils improperly, such as combing hair with a fork. Incontinence, balance problems, and loss of language are common in the advanced stages.
Poor coordination, memory loss, and confusion make for a dangerous combination behind the wheel. If you feel your loved one should not be driving, explain why. If he or she won’t listen, ask the doctor to step in. If the patient still insists on driving, contact the Department of Motor Vehicles for an assessment. Then make an alternate plan for your loved one’s transportation needs.
Exercise can help people with Alzheimer’s maintain some muscle strength and coordination. It also improves mood and may reduce anxiety. Check with your loved one’s doctor to learn which types of exercise are appropriate. Repetitive activities, such as walking, weeding, or even folding laundry may be the most effective at promoting a sense of calm.
As the caregiver of someone with Alzheimer’s, you will probably wear many hats — cook, chauffeur, accountant. While you may have to handle the meal planning and finances, encourage the patient to do some activities independently. It may help to label cabinets with their contents and put up sticky notes with reminders of daily tasks.
Many people with Alzheimer’s have trouble remembering names — even those of close family members. A temporary fix is to put up pictures of friends and relatives with names printed underneath.
Eventually, the individual may no longer recognize faces and may react to loved ones as if they are strangers. Often they may see an adult son or daughter as their spouse or sibling. This can be a distressing time for family members, but they must not take it personally – remind yourself constantly, “it’s the disease”.
While your loved one is still able to make important decisions, contact an attorney about drafting advance directives. These are legal documents that spell out the patient’s preferences for medical treatments and end-of-life care. The patient should designate someone to make health care decisions and manage finances on his or her behalf. This can avoid confusion when your loved one is no longer able to state his or her wishes.
People with advanced Alzheimer’s may lose the ability to walk, talk, or respond to others. Eventually, the disease can hinder vital functions, such as the ability to swallow. Patients in this stage may benefit from hospice care, which provides pain relief and comfort for the terminally ill.