Issues of Behavior and Dementia

It is hard to be general about the actions of a person with a dementia.  There is such range from one person to the next, from one stage of the disease to the next, and from one day to the next. 

 

Many factors may lead to symptom behaviors.  The mood and actions of other people, changes in physical health (such as an infection), and side effects of drugs can affect a person with dementia.

 

Tips for Caregivers

• Try not to take these actions to heart.  Keep in mind that they are a direct result of an illness of the brain.
• Say and do things slowly.  Because the person understands less, he or she can be easily overwhelmed, more so when tired.
• Try to keep things the same.  A routine lessens anxiety and confusion.
• Have simple expectations.  This will make things better for everyone.
• “Out of sight, out of mind.”  Remove things that can cause problems.
• Redirect rather than confront.  Use the person’s short-term memory loss to prevent these behaviors.
• If you cannot figure out what the person is saying, respond to his or her feelings.

Many of your actions will be trial and error.  It may be helpful to keep a log.  Knowing what can lead to conflict helps you to avoid it in the future.  A log may also help you to figure out which actions are most helpful.  If problems persist, consult your doctor or contact the Alzheimer's Association.

Common Behaviors and Dementia

 

Repetitive Questions

 

This is often an early symptom of memory loss and can frustrate caregivers and loved ones.  The person often does not recall asking the same question before.

 

Try to:	Avoid:
Use simple answers and short phrases.	Arguing. Becoming angry.
Write down the answer.	Thinking the questions is being asked again on purpose.
Validate the concern.  (“You keep talking about money.  Are you afraid there won’t be enough?”)
Distract.  Change the subject and ignore further questions.
Assure as needed. ("I can take care of that for you.")
Repeat the answer using the very same words each time

 

Losing, Misplacing, or Hiding Things

 

These symptoms are a direct result of short-term memory loss.

 

Try to:	Avoid:
Reduce clutter to make things easy to find.	Asking the person to think of where the lost item is.
Take away any items of value. (Social Security checks or other papers should go to a different address or to the bank.)	Arguing or confronting.
Build in routines.  (Always leave the glasses in the same place at night when going to bed.)
Approach the loss calmly to convey a sense of safety.
Label drawers and cupboard doors with words or pictures.

Stubborn or Uncooperative Behaviors

 

These actions often occur when goals are too high (for instance, rushing a task or doing complex or scary tasks).  Bathing, changing clothes, or taking pills may bring about such results.

 

This may be caused by

• Short-term memory loss.
• Not grasping what he is being asked to do.
• Anxiety or fear.
• Fatigue.
• Need for privacy (for instance, with bathing).
• Decreased attention to hygiene.

 

Try to:	Avoid:
Keep a set routine.	Rushing.
Use simple commands.	Conflict.  Back off and try later.
Reduce decisions.  For instance, lay out clothes if choosing clothes causes stress.
Plan harder tasks on good days or at a time when the person is the least fatigued.
Hire someone to help.  Often people behave better with a stranger than with family or someone they know very well.
Assure and comfort.
Change what you expect.  A sponge bath may be easier to complete than a tub bath.
Allow the person to do as much of the task as possible.

 

Sleeping Problems

 

Many persons with dementia are restless at night.  Being confused is also often worse at night due to being tired and lack of cues in the dark.

 

Try to:	Avoid
Follow the same nighttime routine.
Increase the amount of activity during the day.  Decrease chances for naps.  Have the person attend an adult day center.	Over-the-counter sleep aids.  These can cause the person to be confused and increase the risk of falls.
Use nightlights to help orient the person.
Reduce the safety hazards in the house in case the person wanders.   For instance, lock the door to the basement stairs.
Consult with the health care team about medicines if nothing else works.

 

Wandering

 

This is a dangerous action that is very stressful and tiring for caregivers.  Wandering may or may not have a purpose.

 

This may be caused by

• Trying to find something or someone.
• Looking for a place, such as the bathroom.
• Too much stimulation, stress or fear.
• Changes in the environment.
• Side effects of drugs.
• Response to illness or pain.

Try to

• Figure out the cause.
• Take the person for a walk at the time of day when wandering is most likely.
• Use cues if the person cannot find the bathroom, such as a sign, picture, or light.
• Keep things simple.
• Consult the health care team.

Safety measures

• Put locks on outside doors.
• Put gates on stairs.
• Use a name bracelet that can be gotten through the Safe Return Program of the Alzheimer’s Association.
• Provide a recent photo to the local police and other basic information.
• Provide a companion.

Catastrophic Reactions

 

When a person with dementia has extreme anger, frustration or anxiety, it is called a catastrophic reaction. 

 

They can be brought about by

• Unfamiliar situations.
• Noise.s
• Being part of a large group.
• Having to think about many things at once.
• Not being able to do a task.
• Being rushed.
• Not understanding directions.
• Fatigue.
• Illness.

An extreme case may include verbal and/or physical abuse.

 

When this occurs, the first thing to do is to restore calm.  This can be done by taking the person away from the issue or by stopping what is causing the problem.  Because the confused person is even less rational than normal, it will not help to argue or explain.  Try to slow down and relax.

 

To prevent reactions

• Maintain a routine when you can.
• Avoid those things that lead to a reaction.
• Break down tasks to one step at a time.
• Avoid rushing.
• Deal with stressful things at the time of the day when the person is the least tired.
• Monitor drug side effects closely.
• Keep a log to see whether there is any pattern that might help to prevent further reactions.
• Consult with the health care team.
• Make sure there is no a physical problem such as an infection.

 

The Alzheimer’s Association is a great source of information.  You can contact them at 1-800-272-3900 or www.alz.org.

 

Another good resource is the Alzheimer’s Disease Education Resource Center.  You can contact them at 1-800-438-4380 or www.nia.nih.gov/alzheimers..

 

References

Kindig, Mary Norton, MSW; Molly Carnes, MD.  Coping with Alzheimer’s Disease and Other Dementing Illnesses.  Singular Publishing Group, Inc. 1993

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 04/10/2008

Copyright © 04/10/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5268

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