Why do Difficult Behaviors Occur?
There are a number of challenging behaviors we associate with Alzheimer’s disease (AD) and other progressive types of dementia. Some of these behaviors include wandering, agitation, not wanting to bathe, and wanting to go home.
Although there are many behaviors that accompany Alzheimer’s disease, it is important to know that behaviors can vary greatly from person to person. Some people with AD or other forms of dementia will become agitated, others will not; some will wander, others will not. Two people with Alzheimer’s disease may experience the same behaviors but at very different times in the progression of the disease. This may be due to how quickly the disease is progressing, what part of the brain is being affected, or other factors.
It is helpful for caregivers to understand WHY a behavior may be occurring. If caregivers understand what might be causing the behavior, it may be possible to prevent the behavior from occurring. And sometimes it is possible, to stop the behavior once it has begun. Let’s look at some of the common causes related to difficult behaviors.
How the Person is Feeling
In addition to progressive brain damage, people with dementia can experience other medical problems that may explain why a change in behavior is happening.
Medications
Some people with dementia can be very sensitive and vulnerable to medications. A combination of drugs—prescription and over the counter—as well as a person being over medicated can lead to increased confusion, and decreased abilities and comprehension. Some medications that are prescribed for agitation and sleep can have the adverse effect and cause an individual to be more agitated or sleep less. Falling, drowsiness or unusual mouth and hand movements can be side effects of some medications. If these problems occur, talk to your doctor immediately.
When a new medication is prescribed by your loved one’s doctor, ask about the potential side effects. Be sure the doctor is aware of ALL medications that your loved one is taking – both over the counter and prescription drugs. Your pharmacist is also a valuable resource and can answer questions about side effects and the combination of two or more medications.
Sudden Illnesses
Urinary tract infections are a common cause of acute change in behaviors. Urine that is discolored and/or has a strong odor can (but not always) indicate a urinary tract infection. A person who does not want to go the bathroom to urinate might be resisting because it is painful to urinate. Taking a urine sample to the doctor can quickly determine if there is an infection. Antibiotics are effective in treating the infection.
Other common acute illnesses to be aware of include pneumonia and gastrointestinal discomfort or infection. A fever can also alter one’s behavior and mood.
Chronic Illnesses
Arthritis, headaches, diabetes and other chronic illnesses can alter one’s level of functioning and mood. Caregivers commonly attribute changes in their loved one to the progression of Alzheimer’s, but it is important not to overlook other medical conditions the person has.
Fatigue
Sleep patterns can change when a person has AD. A disruption or lack of sleep can cause the person to be irritable or agitated.
Depression
It is estimated that between 40% - 50% of people with Alzheimer’s disease suffer from depression. Depression can look much like dementia – impaired concentration, decline in memory, disruption in sleep, lack of energy and initiative. It is often hard to tell if these signs indicate depression or dementia or a combination of both. If you see some of these symptoms, talk to your doctor and ask him to conduct a thorough evaluation for depression.
Physical Discomfort
If a person is too hot, too cold, hungry or thirsty, or needs to go to the toilet and is not able to tell you what she needs, behaviors such as pacing, irritability, agitation may occur. Are the person’s clothes too tight? Do her toe nails need to be trimmed? Many times a person’s oral hygiene is overlooked and a gum infection, cracked tooth, or poor fitting dentures cause pain and discomfort.
Not all change in behavior should be attributed to the progression of Alzheimer’s disease or related forms of dementia. Call your doctor if you have questions about a sudden change in behavior. There could be another cause(s) related to the person’s physical or emotional health.
