Alzheimer’s and Alleviating Symptoms

(UCSF Memory and Aging Center) Aggressive behavior may become more common in some forms of dementia due to the brain’s inability to control impulsive actions.

Aggression

Tips for preventing aggression:

1. Ensure the person does not have pain and see the person’s regular doctor for any illness. A change in behavioral symptoms may be triggered by even minor illnesses such as a cold or by pain such as arthritis.
2. When talking to the person, do not use sarcasm or abstract thinking. Instead, be concrete.
3. Reduce external distractions when talking, e.g., TV, radio, busy places.
4. Maintain routine when possible. If necessary, make changes gradually.
5. Don’t rush the person.
6. Do not argue or insist on being right.

Tips for managing aggression:

1. Maintain your safety and the safety of and others. Call 911 if you need help. Do not try to restrain your loved one by yourself.
2. Keep calm, lower your tone of voice, be aware of body language (may or may not be recognized by patient but will assist in calming you).
3. If there is an incident of aggression, think about what happened prior to the problem that may have triggered it.
4. Do not argue or rationalize.
5. Validate the person’s feelings and empathize (may or may not respond).
6. Offer a distraction: a snack, a walk, a favorite activity.
7. If nothing seems to work, take a break and go in to the next room if possible.

Apathy

Apathy can also be particularly tough for the caregiver to deal with if you forget that it is not personal, it’s the disease changing them.

To increase participation:

1. See if you can figure out what triggers the anxious or agitated behavior – you might be able to avoid setting off the behavior by changing the environment or routine.
2. Make sure your loved one isn’t in pain, hungry or thirsty or doesn’t need to use the bathroom – they may be agitated because they can’t express what they need.
3. If they are aggressive or angry, don’t touch them – it may be threatening instead of comforting.
4. Talk about things that they love to help calm them.
5. Speak in a calm voice and don’t let their agitation agitate you.
6. Try to make sure your loved one is getting enough sleep.
7. Try not to rush or hurry them.
8. Follow a regular daily schedule.
9. Eliminate stressful stimuli and maintain a quiet environment.
10. Try covering your loved one’s eyes with a mask or cloth to reduce fear or anxiety.
11. Don’t try to reason with person (this is limited due to inability to understand consequences).
12. Prompt the person to do the activity.
13. Encourage the person.
14. Start an activity for them.
15. Mirror activity (physically show the person what you want them to do).
16. Don’t take over activity.

Compulsive Behavior

A person with dementia may:

• Check locks and doors over and over
• Have rigid walking patterns
• Hoard items
• Count over and over
• Go to toilet frequently

As the caregiver, you need to decide if the behavior is a problem or just an annoyance that can be ignored. While it seems compulsive to you, it may give the person with FTD a sense of purpose.

If you need to redirect the behavior, try this:

1. Distract the person from what they are doing.
2. Consider that the person may be bored or anxious and trying to find something to do.
3. See if you can use the compulsion as activity or turn it into something useful (like letting the person fold laundry over and over).

Confusion and Impaired Thinking

Progressive dementia can cause confusion and impaired thinking, which can in turn add to frustration, distress and agitation.

The following things may help:

1. Limit environmental activity and noise which may add to confusion.
2. Follow a regular daily routine.
3. Try reminiscing with your loved one by telling stories from your shared past (“I remember when …”).
4. Watch how visitors affect your loved one and keep visits short if they cause distress.
5. If you have outside help, try to keep the same people over time. New faces may cause anxiety.
6. Limit choices when you can – present only two options for dinner or two options for clothing and let your loved one choose. Too many choices can be overwhelming.
7. Minimize distractions like television and radio so that it is easier to focus on the task at hand.
8. Speak to them with a calming tone and comfort them.
9. Speak in shorter, simpler sentences.
10. See if cognitive activities like puzzles, block stacking or picture matching help and interest them.

Delusions

A few people with dementia may have abnormal beliefs called delusions. These delusions can frighten them or cause unusual behavior.

Try this:

1. Avoid arguing or disagreeing with your loved one by denying the delusion
2. Avoid contributing your opinion of the delusion.
3. Respond to the feelings the delusion is causing in your loved one by reassuring and comforting your loved one, i.e., “I see that you are upset. Let’s figure this out together.”
4. Try to redirect your loved one from the delusion to a soothing activity.
5. Turn off a television, radio, or computer if you think any of these may be causing the delusion – your loved one may not be able to tell the difference between entertainment and reality.
6. Limit environmental activity and noise.
7. Use a calm quiet approach and create a quiet environment.
8. Keep areas well lit so things in the room are not misidentified.

Depression and Social Withdrawal

If the patient is experiencing sadness and isn’t interacting much, try this:

1. Try to keep your loved one engaged with activities that suit his/her abilities – card games, reading aloud, talking
2. Physical exercise helps minimize depression – if their condition permits, walk, swim, garden or do something else they enjoy
3. Visitors might help improve mood, especially in the early stages, but watch for signs of agitation or fatigue
4. Validate and accept their feelings – don’t try to force them to be happy and social
5. Talk to your doctor about medications that can help

Difficulty Swallowing

Some people with motor neuron disease may develop difficulty eating and swallowing (dysphagia) as their motor problems progress.

Try this:

1. Discuss preparing pureed food or thickened liquids with your medical care provider.
2. Try nutritional drinks to supplement a decreased diet (ask your health care team for suggestions).
3. Find out how to give regular mouth care, which can comfort your loved one tremendously.
4. Let your loved one guide their food choices – their needs may alter as the disease progresses.
5. Ask your loved one’s Doctor to request a swallowing evaluation.

Eating Problems

People with FTD may develop a strong “sweet tooth”, want to eat only certain foods or have odd combinations of food. They may also eat inappropriately - eat off the plates of strangers in a restaurant or cram too much food into their mouths.

If you need help managing eating behaviors, try these tips:

1. If there are behavioral problems around mealtime, try to figure out the trigger so you can avoid it – is it a particular food? Time of day? The way things are done?
2. Let your loved one direct their diet but see if you can substitute healthier options less healthy ones (fruit instead of candy).
3. Limit the amount of unhealthy snack foods in the house.
4. Serve smaller portions on smaller plates or bowls so that they look larger.
5. Try nutritional drinks to supplement a less varied diet (ask your health care team for suggestions).
6. If chewing and swallowing become difficult, consult your health care team about pureed foods and thickened liquids that might be easier to manage.
7. If you have a meal with friends, prepare them in advance, so that you do not feel embarrassed. You will be surprised how understanding some friends can be.

Hallucinations

A few people with neurodegenerative disease may see or hear things that no one else does or experience them differently than the others around them (hallucinations). It can frighten them.

Try this:

1. Avoid arguing or disagreeing with your loved one by denying the hallucination; try to be reassuring and comforting instead.
2. Avoid pretending you also see/hear the hallucination in order to make your loved one feel better.
3. It’s okay to say, “I don’t see/hear what you do, but I believe you are seeing/hearing it.”
4. Try to redirect your loved one from the hallucination to a soothing activity.
5. Limit environmental activity and noise.
6. Use a calm quiet approach and create a quiet environment.
7. Keep areas well lit so things in the room are not misidentified.
8. Cover glass tables, mirrors and other pieces of furniture that have a high gloss and may create visual disturbances.
9. Avoid the flickering, changing light of a TV which might prompt hallucinations.
10. Turn off a television, radio, or computer if you think that is causing the hallucination – your loved one may not be able to tell the difference between entertainment and reality.

Language

The language problems experienced by people with dementia are likely to worsen with fatigue, illness or stress. But try to clarify the particular language problems your loved one has.

1. If you are talking with someone who has semantic dementia, try to use common words and short sentences.
2. Avoid using “baby-talk” or talking down to them - just be clear.
3. Use positive statements like “I ran” instead of “I didn’t walk.”
4. Be sure to speak slowly.
5. If the person has progressive non-fluent aphasia, give them time to express themselves or try to explore alternate means of expression through writing, art or movement.
6. Reduce environmental distractions like televisions, radios, crowds, etc.
7. Gain and maintain eye contact so that facial expressions can help.

Memory Difficulties

1. Encourage the patient to make lists
2. Use calendars, alarms or other reminders to help jog memories
3. Invite your loved to tell you stories about their past or what they do remember
4. Encourage them to engage in complex activities that they enjoy and are challenged by such as gardening, playing bridge, dancing to music, playing piano

Sexual Disinhibition

People with dementia may at times be sexually disinhibited due to a lack of insight, lack of impulse control and an inability to “read” others’ responses.

Tips for managing sexual disinhibition:

1. State firmly what behavior is not acceptable.
2. Avoid situations which appear to “trigger” the behavior.
3. Tell your family and friends that this is caused by the disease and is not how the person wants to behave.
4. Print “business” cards which explain that the person has an illness and to excuse the behavior. These can be useful for public places, e.g. at the check out in the supermarket (click here to download cards you can print).

Spatial Navigation/Wandering

Wandering is a common problem among seniors with Alzheimer’s.

Tips for managing spatial navigation problems:

1. Consider enrolling in MedicAlert® + Alzheimer’s Association Safe Return®, a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency.
2. Try to minimize change in the arrangement of furniture and objects in the person’s living space.
3. Hang curtains over doorways or paint them to look like windows or bookshelves.
4. Install locks in odd places on entry doors and windows. For example, the person with dementia might not be able to operate a deadbolt placed at the bottom of a door.

Citation

http://memory.ucsf.edu/caregiving/alleviating-symptoms

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