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Managing Unpredictable Behavior in People With Alzheimer's Disease

Behavior management in Alzheimer's disease patients can pose 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 may also become suspicious and suffer from delusions (false ideas that a person firmly believes and strongly maintains in spite of contradictory evidence). He or she may also begin to withdraw from social interaction, wander, become aggressive, and/or become angry and irritable.

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Here are some tips to help you manage the changes in thinking and behavior that often accompany Alzheimer's disease:

  • Maintain skills. 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.
  • Be consistent. Try to minimize any changes in the surroundings or to your loved one's daily routine.
  • 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.
  • Re-word statements. It may help to simplify, or re-word 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.
  • 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.
  • 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. Reminisce with him or her about the family, or activities he or she once enjoyed.
  • 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 your loved one's prescription medications and cause serious side effects.
  • Provide a healthy 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 healthy fluids, such as water or juice.
  • 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. 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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