Below:
• Talking repeatedly about the past
• Fluctuating memory
• Helpful responses
• Driving the car despite safety problems
• Helpful responses
• Unfair accusations
• Helpful responses
• Hallucinations and frightening behaviour
• Helpful responses
• Withdrawing from social situations
• Helpful responses
Note: This article has been localised for an Irish audience. Alzheimer's disease causes the brain to deteriorate, causing severe memory loss, confused thinking and personality changes. As a result, many caregivers find their loved one's behaviour can be perplexing, frustrating and difficult to deal with. But if you understand why the patient is acting in a certain way, you'll be more likely to respond with skill and patience. These guidelines may help you. Talking repeatedly about the past Behaviour: The person repeatedly talks about experiences from the past. Common responses: He is living in the past; he does not want to relate to the present. Alzheimer's interpretation: Although the brain-impaired person's ability to recall recent experiences is becoming less reliable, he still may remember more remote material from the past. This material remains accessible to the person longer and can provide a more meaningful basis for self-esteem and identity. The present has become more threatening and difficult to accept emotionally. The person may also be losing his ability to relate to time and may be confused about the relation of past to present. • Use past memories to make activities in the present more meaningful. |
| •Provide concrete information that distinguished the present from the past; for example, contrast pictures of grown up grandchildren with their childhood pictures. |
| •Set aside time for reminiscing. |
| •Patiently and supportively orientate the person to the present when the confusion is apparent. |
Fluctuating memory Behaviour: The person's abilities fluctuate from day to day or hour to hour; she remembers some things but not others. Common responses: She remembers what she wants to; she is not trying to remember; she must be getting old and senile. Alzheimer's interpretation: It is normal for the memory of all Alzheimer's patients to fluctuate in this fashion. It is a mistake to believe that improved memory on a given day means the condition is improving, however. Some information or events may be easier to remember. Material that is unpleasant or threatening may be more easily forgotten. Helpful responses | •Make the most of good days. |
| •Determine the kinds of information more easily recalled. |
| •Note if a certain manner of presenting information improves some kinds of memory. |
| •Realise that the person will tend to remember more under relaxed and quiet circumstances. |
Driving the car despite safety problems Behaviour: The person continues to drive the car despite safety problems. Common responses: He is being stubborn and showing poor judgement; he should give up driving. Alzheimer's interpretation: Driving gives a person freedom and control of his daily life. Denying he is lost or confused, despite obvious problems, is his way of defending his self-esteem and independence. Confronting him about mistakes may produce more vigorous denial and angry reactions. Despite resistance family members must limit and eventually eliminate the person's driving opportunities. Even during the early stages of the illness, the person is vulnerable in situations requiring quick decisions because his reaction time is impaired. Alzheimer's also affects visual perception, including perception of distance. Concentration difficulties will eventually erode the person's ability to drive safely. For example, if the traffic light before him changes to green but the car at the junction is going through the red light, the brain-impaired person may be unable to decide which change is more important. Too many things are happening at once, and his problem-solving abilities become overwhelmed. Giving up driving is very difficult for most people with Alzheimer's. They may be more willing to stop driving if another health problem, such as visual impairment, is cited as the reason. Most carers will want a loved one to stop driving long before the affected person is ready. Helpful responses | •Enlist the support of other family members in convincing the person to stop driving. |
| •Enlist the help of the person's general practitioner or consultant, solicitor, insurance agent, mental health professional or trusted friend; the instructions of authority figures may be followed more closely. |
| •Discuss the problem with your insurance representative. |
| •Remove keys or dismantle the car's ignition as a last resort. |
| •Understand the person's anger and resentment about such a loss and avoid confrontations about driving difficulties. |
| •Remember that removal of driving responsibilities eliminates the possibility of an unfortunate accident. |
Unfair accusations Behaviour: The person accuses your family and friends of doing things or making up stories about or makes up stories about you Common responses: She is becoming paranoid, losing her mind, being unfair, becoming unmanageable, or trying to hurt or embarrass you; she is getting senile. Alzheimer's interpretation: Such problems are other ways in which brain-impaired persons react to the insecurity created by memory loss. In this case, the problem more directly involves the carer, since the victim is most likely to accuse her spouse and other close family members. Arguments tend to reinforce beliefs. Confrontations and other negative approaches tend to worsen the situation rather than help it. Helpful responses | •Avoid contradicting the person directly, as this may only make her angry and confused. |
| •Avoid highlighting mistakes and give calm and reasonable explanations; communicate a sense that things are all right or will improve. |
| •If something is lost, offer to help find it or suggest specific places it could be found. |
Hallucinations and frightening behaviour Behaviour: The person has hallucinations or bizarre and frightening delusions. Common responses: The person is mentally ill; Alzheimer's is getting worse. Alzheimer's interpretation: Progressive brain impairment affects an individual's ability to interpret information accurately. Hallucinations are often misinterpretations of real sights and sounds. Delusional beliefs represent an attempt to fill in gaps of information and explain what happened. For example, if the person says someone is knocking on the wall and is trying to break into his house, he may really have heard a tree branch rubbing against the house. Insecurity, so often associated with progressive brain impairment, leads the person to interpret events from a fearful and threatened perspective. Suspiciousness is a common response to a person's diminishing control of her world. When a person seems to be talking with someone who is not present, he may not actually see or hear the person, but he may be involved in a delusional belief, such as thinking a deceased person is alive or talking to a child who lives 400 miles away. A number of other problems contribute to hallucinations and delusional beliefs. These include medical problems such as infections, changes in diabetic conditions, or pernicious anaemia. Medications also must be evaluated. Other conditions that impair a person's ability to receive information can contribute to hallucinations or delusional beliefs. Hearing or visual impairment are examples. Helpful responses | •When delusions or hallucinations are observed, consult your general practitioner. |
| •Provide the person with concrete information. |
| •Show support for the feeling of the experience, responding with reassurance. |
| •Avoid arguing or disagreeing with the person, as that will only upset him more. |
| •Try to distract the person, move him to another room, or talk about something comforting. |
Withdrawing from social situations Behaviour: The person becomes disinterested and withdrawn in social situations. Common responses: She does not care about friends or people anymore; she wants you to stay home all the time. Alzheimer's interpretation: The person's cognitive and memory deficits are making it very difficult to follow social conversations and interact appropriately. This inability leads to frustration and anxiety in social situations, thus prompting her to withdraw. This withdrawal may be proceeded by restlessness, tension, and agitation. If the demands on the person are not decreased, she may become more upset or even rude to uninformed observers. Helpful responses | •Provide emotional support and verbal assistance in demanding social situations and observe any obvious changes in the person's anxiety level. |
| •When the person becomes nervous, encourage her to simply withdraw from the social situation for a while. |
| •Anticipate the more demanding situations before they become uncomfortable. |
| •Inform friends about her behaviour and how they can make her participation easier. |
Resources Alzheimer Society of Ireland
Alzheimer House
43 Northumberland Road
Dun Laoghaire
Co Dublin
Telephone 01 284 6616
Fax 01 284 6030 Alzheimer National Helpline 1800 341341
www. alzheimer.ie West of Ireland Alzheimer Foundation
Main Street
Ballindine
Co Mayo
Telephone 094 936 4900
Fax 094 936 4946
www.westernalzheimer.ie Alzheimer Support Group / Dementia Support Group
Highfield Hospital Group
Swords Road
Whitehall
Dublin 9
Telephone 01 837 4444
Fax 01 837 9013
www.highfieldhospital.com This article has been revised by Vhihealthe for its audience and may contain, among other things, information or medical practices that are unique to Ireland. Neither Consumer Health Interactive nor the original author make any warranty as to the accuracy of the article as revised, and assume no responsibility for modified content.
First published June 15, 2004
Last updated July 28, 2006
Copyright © 2004 Consumer Health Interactive
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