Dr. MJ Bazos MD, Patient Handout

Dementia: Caring for Your Loved One

Are behavior problems common in people who have dementia?

Yes. Many people who have dementia--the name for an illness like Alzheimer's disease--have behavior problems such as inappropriate shouting and agitation (being upset, frustrated and confused). Wandering away, resisting care and having disturbed sleep are other common problems. People with dementia may have strange thoughts, or they may imagine they hear or see things that don't really exist (hallucinations).

Why do people with dementia become agitated?

The agitation can have many causes. A sudden change in surroundings can cause people who have dementia to become agitated. Frustrating situations can also cause agitation. For example, a person who has dementia may become agitated if he or she can't get dressed without help or gives the wrong answer to a question. Being challenged about his or her confusion or inability to do things may also make the person agitated. As a result, the person may cry, become irritable, or try to hit, kick or hurt you in some way.

If the agitation has no obvious cause or the person becomes agitated very suddenly, he or she should be seen by a doctor. The sudden occurrence of agitation may be caused by a medicine he or she is taking, or by an infection, illness or injury.

How can I deal with agitation in my loved one who has dementia?

Even if agitation is an ongoing problem for your loved one, there are ways you can deal with it. One of the most important things you can do is avoid situations in which your loved one might become frustrated because he or she fails to remember something or forgets to do something. Try to make your loved one's tasks less difficult. For example, instead of expecting him or her to get dressed alone, you can just have your loved one put on one thing, such as a jacket, on his or her own.

You can also try to limit the number of difficult situations your loved one must face. For example, if taking a bath or shower causes problems, have him or her take one every other day instead of every day. Also, you can schedule difficult activities for a time of day when your loved one tends to be less agitated. It's helpful to give frequent reassurance and avoid contradicting him or her.

What should I do if hallucinations are a problem?

If the hallucinations are not making your loved one scared or anxious, you don't need to do anything. It's better not to confront people about their hallucinations, because you will not be able to convince them that there are no voices or people. Arguing may just upset your loved one.

If the hallucinations are scary to your loved one, you can try to distract the person by involving him or her in a pleasant activity. If distracting the person doesn't work and the hallucinations continue, let the doctor know. He or she may prescribe some medicine to help. This medicine will not get rid of the hallucinations, but your loved one will be less upset by them.

What if my loved one will not go to sleep at night?

First, try to make the person more aware of what time of day it is. Place clocks where he or she can see them. You can also keep curtains or blinds open so that he or she can tell when it is daytime and when it is nighttime.

Substances that contain caffeine may keep your loved one awake, so limit the amount of chocolate, soda containing caffeine, coffee and tea he or she consumes. Try to help your loved one get some exercise every day. Don't let him or her take too many naps during the day. Be certain that the bedroom is peaceful, since it is easier to sleep in a quiet room. If your loved one has arthritis or another painful condition that interrupts his or her sleep, ask your doctor if it is okay to give your loved one a medicine for pain right before bed.

What if wandering becomes a problem?

Medicine usually will not help prevent your loved one from wandering. Sometimes, however, very simple things can help with this problem. It is all right for your loved one to wander in a safe place, such as in a fenced yard. By providing such a safe place, you may avoid a confrontation. If this doesn't work, remind your loved one not to go out a certain door by placing a stop sign on it or putting a piece of furniture in front of it. A ribbon tied across a door can serve as a similar reminder. Hiding the doorknob by placing a strip of cloth over it may also be helpful.

An alarm system will alert you that your loved one is trying to leave a certain area. Your alarm system may just be a few empty cans tied to a string on the doorknob. You might have to place special locks on the doors, but be aware that such locks might be dangerous if a house fire occurs. Also, some people with dementia can open certain types of locks.

Where can I get more information?

The Alzheimer's Association: http://www.alz.org
Johns Hopkins University Press: http://www.press.jhu.edu