Below:
 • Restlessness
 • Helpful responses
 • Being watched and followed around
 • Helpful responses
 • Sudden mood changes and aggression
 • Helpful responses
 • Refusal to bathe
 • Helpful responses
 • Failure to recognise familiar persons or places
 • 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.

Behaviour: The person is very restless, cannot stay still, or is easily agitated.

Common responses: Something is bothering him; he does not have anything to do.

Alzheimer's interpretation: As the disease progresses, agitation and restlessness commonly accompany the insecurity created by the person's diminishing abilities to cope. Denial and rationalisation, which previously helped to block out awareness of functional losses, become less successful protection devices as his problem becomes more pronounced.

Some restlessness may suggest anxiety and underlying fears, though the person cannot always explain these feelings. Too much stimulation can contribute to anxious and agitated behaviour. Medication given to control these symptoms should be carefully monitored, as it can sometimes intensify the symptoms it was prescribed to decrease.

•Use calm, reassuring approach that supports his feelings, even when the underlying source is not apparent.

•If he can say what is bothering him, try to eliminate the source of trouble; if he cannot, avoid pressing for explanations.

•Reduce noise and activity levels.

•Ask the physician if the agitation can be decreased with medication or if medication might be creating the undesired effects.

•Involve the person in an activity that helps burn off excess energy.

Behaviour: The person constantly watches you and follows you around.

Common responses: She wants too much attention; she is overly dependent; she will not entertain herself; she is suspicious and distrustful of you.

Alzheimer's interpretation: This problem develops from the fear and insecurity caused by the person's memory impairment; watching or following the caregiver provides greater security. Such behaviour also promotes her sense of belonging and alleviates her sense of isolation, which might otherwise intensify anxiety and fear.

Mistrust or suspiciousness may develop because the person is less sure of what is happening. Her interpretations of information and her reasoning are less reliable. Some persons develop paranoia or more intense suspiciousness as a response to a more threatening world outside themselves.

•Understand such behaviours as a search for security.

•Identify and alleviate specific fears that are creating insecurity, for example, the fear that you are leaving the house.

•Tell her what is happening and clarify what you are doing.

•Spend time with the person.

•Engage her in constructive activity; ask her to do some supervised things with you.

•Avoid dramatic changes in routine.

Behaviour: The person's moods change for no apparent reason. He gets upset and even aggressive if cornered.

Common responses: The changes are related to medication, changes in his condition, or something you have done; he is losing his mind and cannot control his emotions.

Alzheimer's interpretation: Such mood swings are often related to changes in the body and brain as the disease progresses. The mood swings also can be precipitated by thoughts and ideas the person has but is unable or unwilling to express.

The person may also be experiencing a catastrophic reaction, which means that the person is overwhelmed by too much happening too quickly, has become extremely upset by his confusion and loss of control and cannot respond adequately to the situation.

•Consult a physician if significant mood swings occur without cause or are increasing in intensity.

•Remove the person from the upsetting situation slowly and quietly.

•Be realistic in your expectations and avoid pushing.

•Reduce outside stimulants.

•Avoid expressing anger and frustration.

•Avoid reasoning or arguing, but use non-verbal support such as holding hands in a calming fashion.

Behaviour: The person refuses to bathe and groom; she says she has already done so.

Common responses: She does not care about her personal appearance; she is being stubborn and uncooperative; she is lying.

Alzheimer's interpretation: Regular bathing and attention to personal hygiene lose their social significance for persons with brain impairment. Social judgement and awareness diminish. Since taking care of personal hygiene is the most basic sign of independence, however, it becomes threatening to adults to become dependent upon someone's help to bathe and groom themselves.

Bathing can become embarrassing to the brain-impaired person. Being nude, closed in and helpless in the bath or shower creates a sense of vulnerability that may be frightening.

Because the person is accustomed to bathing regularly, it may make perfect sense in her mind to claim she has bathed.

•Maintain bathing and grooming at regularly scheduled times.

•Make bathing and grooming comfortable and relaxing experiences; offer, for example, a warm bath and relaxing back massage.

•Be aware of potential fears such as anxiety about falling or water that is too hot.

Behaviour: The person fails to recognise familiar persons, places and things.

Common responses: He is getting much worse and is terribly confused.

Alzheimer's interpretation: Due to the kind of brain impairment known as agnosia, the person is gradually losing his function of recognition. What his eyes see no longer can be put together into the previously meaningful and understandable picture. Thus people, places and things he has been around all his life now truly appear unfamiliar.

•Avoiding arguing when this occurs, as conflict will increase the person's confusion and fear.

•Agree that things look different and calmly indicate who you are or identify the thing in question.

•Bring specific and recognisable things to the person's attention to help re-establish contact with the past.

•Avoid rushing the person.

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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