While the underlying cause of the behavioral symptoms of Alzheimer’s disease and related dementias is the illness itself—changes in the brain due to the death of brain cells, there are multiple other factors that may trigger the various behaviors and emotions that can unfold during the progression of the disease. Understanding the cause and effect can help family and professional caregivers better manage situations that may arise.
We all rely on input from our environment to guide us in activities and relationships. An individual with dementia has lost both the benefit of such input and the ability to inform us of their internal world. This absence causes fear, insecurity and frustration, which may present in the form of aggression and agitated behavior.
As a result of cognitive impairment and psychiatric symptoms, a person's basic needs might not be met. The resulting hunger, dehydration, elimination problems and fatigue can produce behavioral changes. Individuals with dementia may stay hungry because of, for example, their inability to feed themselves, depression or loss of muscle coordination. They may show their discomfort through agitated and aggressive behavior. Likewise, they may forget how to pour water into a cup or never ask for a drink due to their inability to communicate. Dehydration can lead to urinary tract infection, constipation and fever—putting individuals at a high risk for delirium and consequently more behavioral problems. Similarly, individuals may forget where or what the bathroom is, and eventually may not recognize the internal cues for urination or a bowel movement. Elimination problems may prompt agitation, aggression, wandering, pacing, and incontinence. Compounding this, they may develop urinary tract infections or constipation which, left untreated, could result in delirium.
Lastly, people with dementia may get tired easily because of wandering, pacing and disruption of the sleep-wake cycle. Fatigue often leads to irritability and aggression. Some Suggestions:
Pain and discomfort from a medical problem (i.e., dental pain, urinary tract infection) or medication side effects can go unnoticed because of the individual's inability to report it due to poor memory and/or loss of verbal skills. In addition, caregivers may have difficulty gauging the individual's pain because the person does not respond to questions. As a result, these individuals may not receive necessary medication or treatment. Those who are in pain and discomfort tend to exhibit verbal and physical aggression, restlessness, wandering and pacing. Some Suggestions:
Individuals with a previous diagnosis of psychiatric disorders, such as schizophrenia, depression or mania, and those with mental retardation are likely to exhibit more behavioral problems when they develop dementia than other individuals without psychiatric illnesses. Those with hallucinations or delusions and who are depressed or manic tend to exhibit more aggressive and agitated behavior. Some Suggestions:
Excessive noise, poor or glaring lighting and cold temperature in the home or a long-term care facility, and overcrowding in a group setting can increase agitation, screaming and aggressive behavior. Any change in the environment or routines, such as bathing and eating, can cause frustration and agitation. As well, boredom that results from lack of activities, and conflicts among residents in a group setting can manifest in behavioral changes. Some Suggestions:
Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel more frightened and frustrated. For example, those with poor eyesight may not eat their food or they may be at risk for falls. Some Suggestions:
A caregiver's attitude and knowledge of dementia affect the care of individuals with the disease. Individuals usually respond to a caregiver's mood and cues accordingly. Some Suggestions:
For more information, connect with the Alzheimer’s Foundation of America’s licensed social workers. Click here or call 866.232.8484. Real People. Real Care.