Dealing with behavioral changes

Caring for a loved one with Alzheimer's disease poses many challenges for the caregiver--particularly as the disease progresses and your loved one's ability to communicate declines.
The changes in the brain that are associated with Alzheimer's disease can lead to unusual and unpredictable thinking and behavior. For example, your loved one may become anxious around family members, neighbors, or friends whom he or she may not recognize or in situations that stray from the normal routine. The person with Alzheimer's disease also may become suspicious and suffer from delusions. He or she may begin to withdraw from social interaction, wander, become aggressive, and/or become angry and irritable.
In some cases, behavioral problems--especially physical aggressiveness and delusions--may require treatment with medications, such as antianxiety or antipsychotic drugs. However, these drugs can have negative side effects, including drowsiness and depression, and can further affect memory.
Following are some tips to help you manage the changes in thinking and behavior that often accompany Alzheimer's disease:
Maintain: Work to preserve your loved one's abilities, particularly those that affect dignity (such as eating and using the toilet), rather than try to teach new skills.
Keep it simple: Follow simple routines, and avoid situations that require the person with Alzheimer's disease to make decisions. Having to make choices can be very frustrating and cause anxiety for a person with Alzheimer's disease. Try to minimize any changes in the surroundings or to your loved one's daily routine. If you have to make changes in routines, do so gradually.
Reword statements: It may help to simplify or reword your statements or requests if the person with Alzheimer's disease doesn't seem to understand. Try to be patient and supportive, especially if your loved one is confused and/or anxious.
Reassure: Reassure your loved one every day, even if he or she does not respond. Use a quiet voice, and be protective and affectionate. If he or she has delusions, be reassuring rather than defensive.
Be calming: If your loved one becomes agitated or aggressive, try playing music or a video that he or she used to enjoy. Keep photos of family members and friends where the person can see them. Label photos with names, if necessary. Reminisce with him or her about the family or activities he or she once enjoyed (sports, hobbies, etc.).
Gently remind: Help your loved one maintain his or her orientation by naming events for the day; reminding him or her of the date, day, time, place, etc.; and repeating the names of the people with whom he or she has contact.
Communicate: Try to understand the words and gestures your loved one uses to communicate. Adapt to his or her way of communicating; don't force your loved one to try to understand your way of communicating.
Watch medications: Be sure your loved one gets the right medications and at the right time. Watch for reactions and possible side effects of medicines, such as depression or agitation. Consult with the doctor about giving any over-the-counter medicines, because they may react with prescription medications and cause serious side effects.
Provide a good diet: Because the effects of dementia can be worsened by poor nutrition, be sure to provide your loved one with a nutritious diet and plenty of healthful fluids, such as water or juice. Limit alcohol consumption, and try to ensure your loved one gets adequate sleep.
Encouragement: Encourage your loved one to exercise his or her mind by reading, doing puzzles, writing, etc., as well as to exercise his or her body as appropriate. However, avoid challenging your loved one to the point of frustration.
Identify triggers: Try to identify any actions, words, or situations that may trigger inappropriate or dangerous behavior. Document any episodes of such behavior so you can try to avoid the triggers in the future.
Adapt the environment: To minimize confusion and anxiety, adapt your loved one's environment to his or her capabilities. Make adjustments as his or her abilities decline. Try placing large labels (with words or pictures) on drawers and shelves to identify their contents. If your loved one tends to wander, you may need to lock the doors, especially at night. Consider participating in the Alzheimer's Association's Safe-Return Program. As part of this program, the person with Alzheimer's disease wears a bracelet with a toll-free number and code. The toll-free number may be called from anywhere in North America, and the code is used to identify the person and alert his or her family of the person's whereabouts.
Be honest: Recognize when the person's behavior is more than you can handle. Safety--your own and your loved one's--must be considered at all times.

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