Managing Care for Behavioral Symptoms

Alzheimer’s disease destroys brain cells, and so over a period of time, the brain slowly changes. In addition to the cognitive symptoms that arise, this also causes behavioral and personality changes to occur. This can be especially hard to watch in a loved one, but remember that this is a result of the disease and not the person. Sometimes medications, the surrounding environment, or concurrent medical conditions can also cause behavioral symptoms, so be sure to rule out other causes so they can be addressed, if need be.

Behavioral symptoms

There are a variety of behavioral symptoms that might occur, and not everyone will experience the same symptoms or symptoms at the same time or to the same degree. In the early stages of Alzheimer’s disease, the person might display some irritability, depression, or anxiety.¹ As the disease progresses, behavior and personality changes become more pronounced and can include^1,2:

• Aggression
• Anxiety and agitation
• Restlessness and wandering
• Hallucinations and delusions
• Depression and emotional distress
• Acting out sexually
• Paranoia
• Physical or verbal outbursts

If caregivers notice any changes in behavior, make sure that the person isn’t in pain or having any issues with soiled clothes, hunger, or thirst. If the changes come on suddenly, talk with their doctor about possible medication interactions or physical ailments like infections or illness.

Ways to cope

It can be hard watching these personality and behavioral changes happen, but there are ways to cope with these changes. Here are some tips^1,2:

• Don’t take it personally – it’s the disease, not the person
• Create a calming, familiar, safe environment for the person
• Use humor whenever possible
• Don’t argue or act confrontationally with the person
• Reassure the person that they are safe, that they are not alone, and that things are okay
• Focus on the person’s feelings, not the words; they may have trouble expressing what’s really going on with them and acting out instead
• Keep things simple and follow a basic routine to help cut down on everyone’s frustration
• Use distractions like music, dancing, or singing
• Use gentle touch or massage to calm the person down, if appropriate – although this might not be for everyone; not everyone likes to be touched
• Make sure the person is comfortable – check on their toileting needs, pain level, hunger, and thirst
• Make sure the person is not irritated by background noise, such as something on the television
• Allow plenty of rest between activities – being overtired can lead to behavior changes and frustration
• Give the person a security object
• Follow a guided meditation

Ask for help when necessary, and if possible, find another caregiver that can help or step in when needed. Many of these symptoms can be frustrating and can even provoke anger for the caregiver. It’s important that caregivers take care of themselves, ask for help when needed, and find ways to remain calm. This can include deep breathing, talking to another friend or loved one that knows what caregiving entails and the presenting situation, going for a walk, or finding comfort in meditation or prayer.

When to call the doctor

If the non-drug coping strategies for the behavioral symptoms don’t work, or if caregivers suspect there may be an underlying medical or physical cause for the symptoms, call the doctor immediately. A thorough examination can help determine whether there are any medical reasons for the changes in behavior or personality, and if a reason is found, it can be treated appropriately and help resolve the symptoms. If the symptoms are new behavior symptoms from Alzheimer’s disease or if the symptoms are not able to be managed by non-drug interventions, the doctor may decide to try medication to help manage these symptoms. There are risks and benefits to each medication, so it’s worth carefully discussing the options if medication is necessary.

Getting support is important for caregivers, as well. If a caregiver is having trouble coping with these behavioral changes, tell the doctor. They may be able to provide caregiver resources like a local support group that can help navigate the challenges these behavioral symptoms come with. Caregiving is hard, but it doesn’t have to be an isolated endeavor.