Disturbing Behaviors and Moods in Dementia: What You Can Do

By Arline Kaplan © 2000 (All Rights Reserved)

"Sometimes he is joyful, other times he is ugly in his behavior, especially his vulgar talk…and he angers easily in crowds of people."

"He has lost interest in everything."

"Daddy left the house for the third time this week. He said he was going back to Nebraska to see Grandpa and Grandma."

Aggression, depression, apathy and wandering are among the disturbing, unpredictable and frightening behaviors and mood changes that are part of Alzheimer’s disease and related dementias.

This illness is robbing your loved one of the ability to think, reason, learn and communicate. So don’t take the embarrassing, hostile or uncharacteristic behaviors and moods personally, but do realize you can take steps to make both of you more comfortable.

Agitation and Anxiety

Your loved one becomes anxious and needs to pace. He or she may seem over-reliant on you for attention and direction. These reactions may arise from feelings of insecurity, confusion, fears of abandonment, frustration or an inability to cope with changes.

• Explore possible causes (e.g., illness or tight clothing)
• Use calming phrases to reassure your loved one. Offer hugs.
• Modify the environment. Decrease noise and distractions or move to another place.
• Find outlets for energy (e.g., walk or do household chores together).
• Substitute an activity for a behavior (e.g., if incessant foot tapping is a problem, play some music so he or she can tap to the beat).
  

Anger and Aggression

Your loved one engages in threats, accusations, name-calling and obscenities or starts hitting, kicking, pushing and scratching. These behaviors can occur suddenly without an apparent reason or result from a frustrating situation.

• Explore possible causes. What happened immediately before the reaction that might have triggered it?
• Stay calm, move more slowly, and speak with a soft tone.
• Use gentle music, massage or hair brushing to facilitate relaxation.
• Distract with something of interest. The immediate activity may have triggered the aggressive response. Switch to something different.

Apathy

Your loved one seems indifferent to activities he or she once loved, lacks motivation to do anything or is withdrawing from social situations. Apathy often results from feeling overwhelmed by an incomprehensible environment or from extensive damage to the brain.

• Allow your loved one to be a spectator or passive participant to activities.
• Engage in nonchallenging activities (e.g., watching television or taking walks).
  

Catastrophic Reactions

• Your loved one overreacts to a request, task or situation. The resulting behaviors may include stubbornness, crying, verbal and physical striking out. Emotional regression may occur (e.g., calling out for long-dead relatives as if they were still alive). These reactions can result from overwhelming physical and emotional demands, too many questions, noise, criticism and fatigue.
• Avoid noisy public places, crowds and rushing from place to place.
• Restructure daily rituals to accommodate his or her best time of day.
• Simplify tasks and offer praise.
• Soothe with music (e.g., a Walkman tuned to mellow mood station).
  

Depression

Your loved one expresses persistent feelings of worthlessness or guilt or thoughts of death or suicide. Lose of independence and feelings of failure can trigger depression.

• Notice which activities or people trigger a decline or improvement in your loved one’s mood.
• Arrange for an evaluation by a mental health professional.
• Engage him or her in simple, familiar projects (e.g., raking leaves), where success is possible and praise is easily given.
  

Rummaging, Hiding, Hoarding

Your loved one rifles through drawers, closets, throwing everything out or attempting to rearrange objects. He or she may hide or hoard items and then forget where they are. These behaviors usually occur out of fear or confusion.

• Fill a top drawer with things that are "rummagable," and let him or her go through it.
• Give him or her an organizing task (e.g., sorting buttons in a sewing drawer).
• Lock drawers and closets you want to keep safe.
• Try identifying favorite hiding places when looking for lost items.

Sleeplessness and Sundowning

Your loved one experiences periods of increased confusion, anxiety, agitation and disorientation beginning at dusk and continuing into the night. Causes of these behaviors can include a recurrent medical problem, end-of-day exhaustion, upset in the body’s sleep-wake cycles, reduced lighting and increased shadows and less need for sleep.

• Investigate possible medical problems (e.g., incontinence).
• Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early.
• Encourage daily activities (e.g., walks).
• Leave lights or night-lights on in bedroom and bathroom.
• When your loved one awakens at night and is upset, determine if he or she needs anything. Offer assurance that everything is all right.
• Encourage him or her to take a soothing bath before bedtime.
  

Suspicious Thoughts and Delusions

Your loved one becomes suspicious and may hear or say things that exist only in his or her mind. Common delusions are of theft and burglary; of a spouse being unfaithful; of phantom boarders within the house; of someone seen on television coming into the house; and of friends and family members being imposters.

• Avoid confronting, arguing or trying to reason with your loved one, and don’t take it personally.
• Understand and accept his or her feelings.
• Distract your loved one and redirect him or her into some reality-based activity (e.g., eating a snack or watching a favorite video.

Wandering

Your loved one roams from room to room at home, or leaves home with no goal in mind. Causes of wandering include agitation; the need for food, drink or the washroom; the need to find "lost" items; and disorientation.
       •Ask loved one if there is something he or she needs.

• Allow wandering where environment is safe.
• Discourage daytime napping to reduce night wandering.
• Engage in daily exercise or simple games to release pent-up energy.
• Secure home entryways (e.g., deadbolt locks), use safety gates on stairs, and install door sensors and motion detectors to alert you when your loved one is wandering.
• Carry a recent picture of loved one and use the Alzheimer’s Association’s Safe Return program. Call (888) 572-8566 or write Safe Return, P.O. Box 9307, St. Louis, MO 63117-0307.

(Sources for this information page include the Alzheimer’s Association, What You Need to Know About Alzheimer’s by John Medina, Ph.D., and The Dementias—Diagnosis, Management and Research edited by Myron F. Weiner, M.D.)

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