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Blog | Behavioral changes in Alzheimer's disease

Alzheimer's dementia is a comprehensive and long-term disease. In addition to changes in cognitive functions and impairments in the ability to do everyday things, there are behavioral changes and alterations in the person who suffers from it.

It is a very complex disease. There is a progressive loss of the person's abilities that can lead to confusion, disorientation, feelings of insecurity, anxiety, frustration, sadness, as well as misinterpretations of reality, among others.

The patient's personal environment, his family and especially his primary caregiver, are also part of the dementia process. They are therapeutic agents, that is, their attitudes and behaviors intervene favorably or unfavorably in the course of the disease. Depending on how we act, how we respond or react, what we demand or ask for, we can facilitate or prevent the appearance of behavioral alterations. Therefore, it is very important to have knowledge about the disease, the symptoms that may appear and how to behave.

People with dementia are often unaware of their limitations and needs, which can lead to oppositional behavior when we try to help them, or they may refuse to take the medication because they think they do not need it.

The following are 6 situations that we may encounter and what would be the best way to address them for family members and caregivers:

1. People with Alzheimer's disease may manifest depressive symptoms and apathy. Their initiative and motivation to do things diminishes and they tend not to want to do anything. They may feel sad, have more difficulty to do and enjoy the things they used to like, lose interest in their personal appearance and their surroundings. They tend to isolate themselves. They may have emotional instability with sudden changes in their mood.

As caregivers, we must act with great patience and tact, offering help to the person without invalidating them or making them feel bad, without evidencing memory deficits. Build trust and obtain the person's consent.

2. In the face of increasing confusion and difficulties to cope with the demands of the environment, anxiety or abnormal motor behavior may also appear. They are restless, worried, afraid, they may perform repetitive actions without any specific goal such as constantly moving things around or walking non-stop and aimlessly.

Caregivers should provide and share activities that they can enjoy and increase their self-esteem. Enhance the person's sense of usefulness and give affection.

3. The person may be more irritable, easily angered and may show agitation and aggressiveness, especially when contradicted. They can raise their voice, insult, push, as well as throw objects or hit.

We must provide security and distraction by avoiding over-stimulation. Calm the person, introduce habits and routines, and provide a safe environment.

4. Behavioral disinhibition and/or impulsive behaviors may also appear, as the person may have difficulty assessing what behaviors are appropriate or not. Sometimes they can engage in childish or inappropriate sexual behavior, they may undress in public or say things that may hurt others’ feelings, or not respect their turn in a queue.

People with Alzheimer’s are generally misinterpreting the situation. We must remain calm and try to empathize with them in order to understand what is causing this reaction. Avoid getting too close if they can physically attack us and try to avoid the word “no” as it can provoke an aggressive reaction.

5. An altered perception of reality may occur and cause delusions or delusions and hallucinations. Thus, the person may express suspicion and distrust and have beliefs about things that are not real, such as that someone wants to harm them, ideas of theft, hear voices or see people who are not there.

We should avoid arguments and the use of reasoning to convince the person of their wrong perception. We should not deny what they are experiencing as real but rather reassure, calm and distract them.

We must be aware that their reaction is only the result of a misinterpretation of reality. Hence, we must ensure the dignity and integrity of the person, provide appropriate environments for the conduct and explain, if necessary, that the way they are behaving is not the result of a conscious act.

6. Changes in eating behavior can also occur, showing excessive, compulsive or insufficient intake, as well as sleep disturbances with insomnia, or frequent awakenings such as hyperinsomnolence.

In the face of any behavioral alteration we should analyze when it occurs and, if possible, identify and modify the possible triggers such as unmet needs (biological or emotional), environmental factors (high noise, routine changes), changes in their health status (infections), or an inadequate approach by the caregiver (excessive demands, confrontation).

The attitude of family members and caregivers is a factor to be taken into account in the course of the disease. For this reason, it is important to take an open and empathic stance, to be aware that behavioral disorders are involuntary and often do not have a specific treatment, they are without bad faith and the result of dementia. Therefore, should not be confronted or taken as personal attacks.

A close and understanding approach is the best solution to improve the situation of both the person with Alzheimer's and those around him.

If the person or caregiver is suffering and non-pharmacological measures and strategies do not work, it is necessary to inform the doctor in order to assess the advisability of prescribing pharmacological treatment.

PILAR CAÑABATE

Head of Social Work at Ace Alzheimer Center Barcelona

MARINA GUITART

Daycare Center Coordinator at Ace Alzheimer Center Barcelona