Alzheimer's Disease: Responding to Unusual Behaviors

A look at behaviors associated with Alzheimer's Disease and how to respond to them.

Understanding and Responding to Challenging Behaviors in Alzheimer's Disease

People with dementia sometimes behave in ways that other people find puzzling or difficult to handle. There are a number of different behaviors and ways of coping.

Not everyone with dementia will be affected. Each person with dementia is an individual with different needs. Much of their behavior is an attempt to communicate what they want or how they are feeling. Once we understand the reasons why someone is behaving in a particular way, it is easier to find ways of coping.

If the person is unable to tell you how they are feeling, try a number of approaches. Ask for advice from professionals or other caregivers before you become too stressed.

Medication may sometimes be used for these behaviors. These treatments will need very careful monitoring by the doctor and should be reviewed regularly. Ask about the side-effects of any drugs so that if they appear you do not automatically assume that the dementia has become worse.

Always remember that the person you are caring for is not being deliberately difficult. Ask yourself too whether the behavior is really a problem. Make sure that you have support for yourself and breaks when you need them.

Repetitive questioning with Alzheimer's

A person with dementia may ask the same question over and over again. They probably do not remember asking the question or the answer you gave because of their short-term memory loss. Feelings of insecurity or anxiety about their ability to cope may also play a part in a person's repetitive questioning. Always try to put yourself in their situation and imagine how they might be feeling and what they might be trying to express.

• Try to be tactful when answering. Don't say: 'I've already told you that', as this will increase feelings of anxiety. Try to get the person to find the answer for themselves if possible. For example:
  Q- 'Is it lunch time?' Answer: 'Have a look at the clock.'
  Q- 'Do we need more milk?' Answer: 'Why don't you look in the fridge?'
• Try to distract the person with an activity if appropriate.
• If you cannot contain your irritation, make an excuse to leave the room for a while.

People with dementia often become anxious about future events and this can lead to repetitive questioning. If this seems to be the case consider telling them that someone is coming to visit or that you are going shopping just before it happens. This will give them less time to worry.

Repetitive phrases or movements with Alzheimer's

Sometimes people with dementia repeat the same phrase or movement many times. You may hear this referred to by medical professionals as 'perseveration'.

• This may be due to some kind of discomfort. Check that the person is not too hot or too cold, hungry, thirsty or constipated. Contact the GP if there is any possibility that they are ill, in pain or if medication is affecting them.
• They may be finding their surroundings too noisy or too stressful.
• They may be bored and trying to stimulate themselves. Encourage activity. Some people find stroking a pet, going for a walk or listening to favorite music, for example, is very enjoyable.
• It may be the person's way of soothing themselves. We all have different ways of comforting ourselves.
• It may be due to the damage in the brain.

Simply offer as much reassurance as you can.

Sometimes, of course, repeated questions may not stop despite your best efforts. In a memoir about caring for her elderly husband who had Alzheimer's, Lela Knox Shanks recalls, "In the beginning, when Hughes asked the same thing over and over again, I wanted to scream and sometimes did -- but that was not a satisfactory solution. I learned ... to write notes to Hughes during that stressful period. Since he asked the same questions every day, I accumulated a set of stock answers that I flashed to his questions. By keeping silent I was better able to remain calm, [and] Hughes never questioned why I was communicating with him through signs."

Repetitive behavior with Alzheimer's

You may find that the person seems to be constantly doing the same thing such as packing and unpacking a bag or rearranging the chairs in a room.

• This behavior may relate to a former activity or occupation such as traveling, organizing an office or entertaining friends. You may be able to work out what this activity might be. This may help you understand what the person is feeling and trying to do, and may also serve as a basis for conversation.
• The person may be bored and need more activities to stimulate them or more contact with other people.

Here are strategies from the Alzheimer's Association and Family Caregiver Alliance to help you cope with repetitive behavior:

• Look for patterns. Keep a log to determine if the behavior occurs at a certain time of day or night, or whether particular people or events seem to trigger it.
• Keep track so you can tell whether your loved one might be hungry, cold, tired, in pain, or in need of a trip to the bathroom.
• Check with the doctor to make sure your loved one isn't suffering from pain or the side effects of medication.
• Speak slowly and wait for your loved one to respond.
• Don't point out that he or she just asked the same question.
• Distract him or her with a favorite activity.
• Use signs, notes, and calendars to help decrease anxiety and uncertainty. In the early stages of Alzheimer's, when your loved one can still read, he or she may not need to ask about dinner if a note on the table says, "Dinner is at 6:30 p.m."

Talking with friends, a counselor, or a support group about your grief and frustration at the damage caused by Alzheimer's also leaves you free to cope with its reality and to cherish your loved one as he or she is. "So many times we talk about caregiving in a somewhat negative fashion," says Jan Oringer, of the Family Caregiver Alliance. "But I see a lot of families where this has been an opportunity to grow, and to find more adaptive ways of solving difficulties. These aren't just caregiver skills, but life skills all of us need."

Sources:

• Caring for People with Alzheimer's Disease: A Manual for Facility Staff (2nd edition), by Lisa P. Gwyther, 2001.
• Virginia Bell and David Troxel. The Best Friends Approach to Alzheimer's Care. Health Professions Pr: 1996. 264 pp.
• Dr. William Molloy and Dr. Paul Caldwell. Alzheimer's Disease: Everything you Need to Know. Firefly Books. 1998, 208 pp.
• National Institute on Aging, Understanding Stages and Symptoms of Alzheimer's Disease, Oct. 2007.
• Alzheimer's Association