Understanding Behaviors and Emotions

Some people find the loved-one in their care almost seems like a stranger - perhaps morphing from a kind and helpful person to a combative and vulgar one. Other times, dementia seems to magnify personality traits. When this happens people often say, it’s my father only “more so.” 

Though difficult, do try to remember it is the disease and not the person who is responsible for these worrisome, and sometimes embarrassing, changes to his or her temperament. 

Dementia alters and destroys brain structures. The consequences of the damage include loses in the ability to accurately process and relay information. Another outcome is the inability to control emotions such as anger and censor impolite and socially inappropriate behaviors. Because of the progressive nature of dementia behavioral changes tend to worsen with time.

Emotional blunting, or the inability to express verbal and non-verbal feelings, is another characteristic of having dementia. The inability to express needs and feelings can make people who have dementia angry, combative, and sometimes violent. Many people who have dementia experience depression. 

Dementia can also affect sexual behaviors in ways that are often unpredictable. Some people who have dementia cannot understand that it is impolite to touch or expose their private areas in public or make unwanted or inappropriate sexual advances.

There are many simple ways to reduce the incidents and intensity of these difficult-to-manage behaviors. However, first consider other reasons for your loved-one’s difficult behaviors. Drug interactions and side effects may intensify dementia symptoms, cause hallucinations, as well as intensify agitation and combativeness. Others explanations for uncharacteristic behaviors and emotions can include pain, fatigue, over stimulation, as well as other medical problems such as a bladder infection.

There are many strategies you can use to prevent or diffuse your loved-one’s outbursts. Perhaps the most important one is communication. Do not argue with your loved-one, remind them of what they have forgotten, or ask probing questions to assess their memory. Use supportive language to affirm you are listening, respecting his or her concerns, and responding in an appropriate manner. For example, it is better to respond to fearful, but unlikely true incident is to say, “I’ll look into it” rather than “don’t be silly.” Sometimes all it takes to is a calming hug or a kind and supportive touch.

Distraction and redirection is another useful way to diffuse anger or sexually aggressive behaviors. Give your loved-one a snack, go for a walk, point-out a pretty flower or talk about the weather.

Sometimes your loved-one’s behavior is more than you can handle. When this happens, calling the Crisis Intervention Team, rather than 911, may be the best option. The Crisis Intervention Team, (CIT), refers to the police officers in your community who have special training in how to manage a variety of behavioral, drug-related, and mental health crises. 

Having the CIT there to help with unmanageable or threatening behavior can prevent a difficult situation from escalating to something worse. The CIT can also accompany you and your loved-one to the medical facility. Be sure to include the phone number of your local CIT in your list of emergency phone numbers. 

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

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