Further Your Understanding: Dementia and Mood

Some people say Dementia turned their once loving and upbeat loved-one into an angry tyrant. Others may describe the changes in behavior and mood as “the same person, only more so.” Usually, “more so” is not good. Rarely does one hear that Dementia turned a difficult person into a pleasant one.

The behaviors associated with early-stage Dementia can be the most difficult. Your loved-one is fighting the imposed changes the diagnosis has brought to his or her life. And you, the family caregiver, do not have the experience to both calm your loved-one and cope with the disquiet this new relationship brings into your life.

As Dementia progresses from early to late-stage, moods, and behaviors worsen. In addition to increasing memory loss, depression, belligerence, apathy, physical aggression, wandering, repetitive questioning enters the picture.

It is useless to try to convince your loved one that what they truly believe is not what it seems. You will never win the argument.

“Distraction and redirection” is one helpful strategy to diffuse the situation. Rather than trying to prove his or her hat was misplaced and not stolen, make a comment about the nice weather and suggest going for a walk. Another way to address your loved one’s concern is to listen and tell him or her you will look into the matter. This simple tactic tells your loved-one you are there; you care, and you will make things right.

“Therapeutic deception” is another approach to managing difficult behaviors. Telling your loved one, “you will make things right,” isn’t a lie. It’s a kindness that gives him or her, and you as well, a few moments of peace. You will find a therapeutic deception is an approach you can apply to various difficult circumstances.

Dementia behaviors may also include some weird and scary things. More specifically, your loved one may experience hallucinations. How you respond to these unsettling behaviors has the potential of turning uncomfortable moments into situations that may necessitate assistance from your local police department or a trip to the emergency room.

Managing the difficult behaviors associated with hallucinations involve a different set of challenges. Telling your loved one, there isn’t any blood on the walls or bugs crawling up his or her back is fruitless. Hallucinations are sensory tricks. Your loved-one sees, hears, or feels something without the stimulus of light, sound, or touch. To prevent a difficult situation from escalating into one you cannot manage, you might say something like, “I cannot see what you see, but I am sure it is very scary.”

You might remind your loved one that you are there and that you will make sure they are safe. Sometimes a hug or a gentle touch will have a calming effect. Other times, when hallucinations cause overwhelming fear, the only thing you can do is take your parent to the emergency room.

Medication to reduce mood and behavioral difficulties is a controversial issue. Some people believe the drugs used to manage behavior are “chemical straight-jackets” meant only to make things easier for the caregiver. Other caregivers subscribe to the philosophy that providing meaningful activities for the person with Dementia, establishing a structured routine, and creating an enriching and pleasant environment can reduce the need for behavior modifying medications. In either case, one has to consider quality-of-life. Medication can reduce pain and suffering. If depression becomes overwhelming, belligerence creates a dangerous environment for the caregiver, or when hallucinations cause unrelenting terror, medication is both the humane and one that supports a better quality-of-life.

All of this is easier said than done, but do try to remember it is the disease that is speaking and not the person you once knew.

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

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

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.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org