Behavior Changes Associated With Alzheimer's and Dementia

A loved one has been diagnosed with Alzheimer's or other type of dementia and lately you notice uncertainty, fear, frustration, periods of greater memory loss, and even anger!  What's causing these changes and how can I manage them?  In order to understand these behaviors, we need to understand the disease.  In basic terms dementia is the development process in reverse.  Reasoning, judgement, and abstract thinking are among the last abilities to develop and among the first to go.  Memories are much the same; more recent memories will be lost quickly while memories from earlier in life will remain intact longer.  This helps to explain why a person might do fairly well in the home they have lived in for the past fifty years but can't manage well at all in an unfamiliar setting.  How does all of this relate to behavior changes?  Early stages of Alzheimer's and dementia are typically the most difficult for the patient.  They realize something is wrong but can't figure out why.  Many times this translates into either frustration or anger.  This is also a period in the disease process where you will notice confabulation - a plausible but imagined memory that fills in gaps in what is remembered.  The person often seems more on edge and may get agitated when asked questions.  As the disease progresses fear becomes more prevalent.  There can be two causes.  First, frustration and anger can become fear as the person feels less control over themselves and their surroundings.  The other relates to memories.  As the disease progresses fewer new memories are available to recall so the brain brings up older memories it can still access that relate to the current situation.  The actual situation, however, may not relate completely to the memory.  In the earlier stages, confabulation helped make the pieces fit.  Now things just don't make sense.  The more things don't make sense, the more fear plays a part.  Every person's reaction to fear is different: Some become protective of themselves, pull away from people and may seem paranoid; some may react with fight or flight - an innate reaction to danger to either stay and fight the danger or run away from the danger to protect yourself - and elopement can become a risk; some may seek protection from others, never wanting to be alone.  You may also begin to notice that anything out of the ordinary will increase the frequency and/or intensity of these behaviors.  While dementia can ultimately affect intelligence it may not occur in the early stages so your loved one will look for solutions to the problem and react.  The problem here is that you may not understand what they are reacting to and the actions will seem irrational or harsh.

So how do you cope with these nightmare?  Begin with the realization that all types of dementia are progressive and will get worse with time.  Again, everyone is different.  I've had people who moved slowly through the disease over two decades, and I've had people who progress through the disease in less than two years.  Establishing a time line is nearly impossible but understanding the disease will help you be prepared.  Routines and rituals are your go-to tools.  When each day is like the last and the next, behaviors will be less frequent and less severe.  Awake at 7:00, breakfast at 8:00, lunch at noon, supper at 5:30, bed time at 10:00.  Meds at 8:00, noon, 5:00 and bedtime.  A walk after breakfast, a nap at 2:00.  The routine itself is not as important as having the routine.  The body will develop a natural rhythm.  When you need to break the routine be prepared for increases in behaviors.  Plan to have extra help for the day.  Explain things in small steps and be prepared to repeat yourself.  Try to include something that will bring back a good memory.  Need to go to an appointment?  Stop at a favorite restaurant for lunch or a cup of coffee afterwards.  Appear organized and at ease.  If you are upset, your loved one will be too.  Finally, be prepared to recognize when the situation progresses to the point where you can no longer do it all yourself and need help.