Alzheimer’s disease is a progressive neurodegenerative disorder characterized by memory loss, cognitive decline, and behavioral and psychological symptoms like depression, apathy, agitation, and inappropriate behaviors. As Alzheimer’s destroys brain cells and connections, people lose their ability to communicate, think logically, and behave appropriately in social situations. But does Alzheimer’s directly cause inappropriate behaviors, or do these result from other factors? Let’s explore this complex question.
What Is Alzheimer’s Disease?
Alzheimer’s disease is the most common cause of dementia, accounting for 60-80% of cases. It is a progressive brain disorder that damages and eventually destroys brain cells and connections. As more neurons die, the brain shrinks dramatically.
Some key facts about Alzheimer’s:
- It is not a normal part of aging, but age is the biggest risk factor.
- Symptoms gradually worsen over years as more brain tissue is lost.
- Early signs include memory loss and mild cognitive impairment.
- There is no cure, although medications can temporarily improve symptoms.
- It is ultimately fatal, as it destroys parts of the brain needed for basic bodily functions.
Alzheimer’s impacts regions of the brain involved in memory, cognition, behavior, and personality. As these areas degrade, people experience confusion, memory loss, difficulty thinking and problem solving, and personality changes.
Behavioural and Psychological Symptoms
In addition to cognitive symptoms, most people with Alzheimer’s experience behavioral and psychological symptoms like:
- Depression
- Apathy and social withdrawal
- Mood swings
- Anxiety
- Agitation and aggression
- Wandering
- Sundowning (confusion in the late afternoon/evening)
- Suspiciousness and paranoia
- Hallucinations
These often arise due to the breakdown of behavioral control systems in the brain. A key feature is the loss of inhibition – the filters that normally stop us from doing socially unacceptable things. This can lead to inappropriate behaviors like aggression, disinhibition, and sexually inappropriate acts.
Let’s look closer at some inappropriate or risky behaviors seen in Alzheimer’s:
Aggression and Agitation
People with Alzheimer’s may become aggressive or combative, especially when frustrated, confused, or during personal care activities like bathing. Aggression seems to result from brain changes rather than intent or personality flaws.
Wandering
Six in ten people with dementia wander off or get lost at some point. This can lead to injury or situations like getting lost while driving. Wandering stems from memory loss, restlessness, disorientation, and trying to fulfill past roles like going to work.
Socially Inappropriate Behaviors
Losing one’s filter can lead to behaviors like inappropriate sexual remarks, disrobing, rude comments, or racial slurs very out of character for the person. This disinhibition and impulsiveness comes from damage to behavioral control systems in the frontal lobe. The person isn’t behaving intentionally or maliciously.
Difficulty Adapting
People with Alzheimer’s cope poorly with change and transition. Something as minor as a changed appointment time can trigger agitation. Inflexible thinking and inability to regulate emotions lead to behaviors like yelling or refusing to move.
Repeating Questions/Actions
The memory loss of Alzheimer’s makes people repeat questions, stories, and actions over and over. To caregivers this can seem rude, irritating or intentional, but it is a symptom of the disease.
Apathy and Depression
Apathy affects nearly half of people with Alzheimer’s. They become withdrawn, inactive, and lose interest and motivation. Depression also frequently occurs, causing sadness, anxiety, and loss of self-esteem. Both apathy and depression are brain-based symptoms.
Paranoia
Memory loss and inability to recognize familiar people and places can cause suspiciousness, fear, and paranoia in people with Alzheimer’s. For example, they may accuse their spouse of being an imposter or sneak out thinking their caregiver is dangerous.
Causes of Behaviors in Alzheimer’s
There are many possible causes of these difficult dementia behaviors:
- Brain damage – This directly impacts personality, inhibitions, and behavior regulation in the frontal lobe.
- Stress and frustration – Not remembering, following conversations, or performing familiar tasks is stressful.
- Fear and insecurity – The world becomes unfamiliar which causes fear and uncertainty.
- Physical pain or discomfort – This may be untreated or under-treated in people with dementia.
- Poor communication – Not being able to understand or express needs can lead to combativeness.
- Fatigue – Exhaustion exacerbates behavioral symptoms.
- Medications – Some drugs have side effects like agitation or restlessness.
- Psychiatric illness – These may be exacerbated by Alzheimer’s (depression, schizophrenia, etc.).
While Alzheimer’s itself does not directly cause behaviors like aggression or wandering, it damages the brain in ways that diminish self-control and understanding. The person is not behaving badly on purpose.
Managing Inappropriate Behaviors
Caring for someone with Alzheimer’s who exhibits difficult behaviors can be challenging. Some tips include:
- Try to find triggers and prevent or avoid them.
- Provide a calm, structured routine to ease confusion.
- Allow regular exercise to relieve restlessness.
- Use memory aids like signs and notes as reminders.
- Reassure the person and remain patient.
- Reduce noise, clutter, and distractions in their environment.
- Ensure they are not in pain or constipated, which can cause agitation.
- Validate their feelings and give them space if they are combative.
- Use distraction and engage them in activities.
- Consult a doctor about potential medication if needed for safety.
Caregiver support, respite, and counseling can also help manage the stress of behavioral challenges. Educating others that difficult behaviors stem from the disease rather than the person can reduce stigma.
The Progression of Alzheimer’s and Behaviors Over Time
Alzheimer’s impacts each person differently, but behaviors tend to worsen in stages as cognitive decline progresses:
Mild Alzheimer’s
– Memory lapses
– Difficulty finding words
– Losing items
– Decreased ability to organize and plan
– Social withdrawal
– Irritability
– Depression
Moderate Alzheimer’s
– Worsening memory loss
– Confusion about time and place
– Changes in personality
– Suspiciousness
– Hallucinations
– Wandering
– Losing inhibitions
– Agitation
– Restlessness
– Anxiety
– Repetitive questioning
Severe Alzheimer’s
– Unable to communicate
– Loss of ability to walk
– Needs help with activities of daily living
– Potential aggression
– Difficulty swallowing
– Weight loss
– Seizures
– Skin infections
– Groaning, moaning, or grunting
Behaviors tend to worsen over the 8-20 year course of the disease as the person declines both cognitively and physically.
The Link Between Alzheimer’s and Specific Behavioral Symptoms
Research helps shed light on which inappropriate or risky behaviors have a direct link with Alzheimer’s versus other causes:
Wandering
Directly caused by Alzheimer’s – spatial disorientation and trying to complete habitual tasks like going to work are brain-based symptoms. Agitation can also trigger restlessness and pacing.
Aggression
Linked to Alzheimer’s – damage to behavioral control centers of the brain reduce inhibition. Pain, stress, and environment are also factors.
Repetitive questioning
Direct result of Alzheimer’s – short-term memory loss leads to repetitive statements and questions. The person cannot retain clarifying information.
Delusions
Tied to Alzheimer’s – misidentifying people and places can lead to paranoia and false beliefs. These serve as a coping mechanism.
Depression
Related to brain changes and stress of Alzheimer’s. May also be worsened by personal history of depression.
Disinhibition
Alzheimer’s destroys filters and impulse control. The person acts on urges without restraint.
Refusal to bathe
Linked to not remembering self-care routines, lost initiative, fear of water, and discomfort being bathed by others.
Sexual Behavior
Partly due to Alzheimer’s disinhibition, but often related to history of sexuality. Can be triggered by needs for intimacy and touch.
The Stages of Alzheimer’s Progression
Alzheimer’s gradually worsens in stages over a span of years:
| Stage | Characteristics | |||
|---|---|---|---|---|
| Preclinical (Pre-Alzheimer’s) | – No symptoms | |||
| Mild (Early-Stage) | – Memory lapses | – Mood/personality changes | – Difficulty with complex tasks | |
| Moderate (Middle-Stage) | – More extensive memory loss | – Confusion and disorientation | – Struggles with speech and language | – Requires more assistance |
| Severe (Late-Stage) | – Unable to communicate | – Total loss of independence/round-the-clock care needed | – Physical immobility | – Difficulty swallowing |
Tips for Dealing with Alzheimer’s Behaviors
Caring for someone with Alzheimer’s who exhibits difficult dementia behaviors can be challenging. Here are some tips:
Learn the Person’s Triggers
Pay attention to what scenarios tend to cause outbursts like aggression or restlessness. Avoid or manage triggers like overwhelmed environments, fatigue, and hunger.
Keep a Routine
A predictable routine helps ease anxiety and confusion in someone with Alzheimer’s. Ensure they get enough sleep and take medications at the same times daily.
Allow Plenty of Exercise
Physical activity and outdoor walks can help minimize restlessness and wandering. Exercise also improves mood and sleep.
Adapt the Home Environment
Reduce clutter, noise, and disruption at home. Add nightlights, memory aids, calendars, and signs to help provide orientation. Secure exits if wandering is an issue.
Engage in Activities
Have the person assist with simple chores like folding laundry or watering plants. Engage them in reminiscence, music, crafts, and other hobbies they enjoy. This provides stimulation and distraction.
Validate Feelings
If they are angry or fearful, avoid debating the reality. Validate how they feel – “You seem really worried right now”. Reassure and provide comfort.
See the Doctor
Discuss behavioral changes with the doctor to identify potential medical issues like pain or UTI causing agitation. A doctor can also advise if medication is needed for safety.
Common Alzheimer’s Behaviors
Some of the most frequent challenging behaviors seen in people with Alzheimer’s disease include:
– Aggression – combative outbursts, hitting
– Wandering/elopement – aimless pacing, getting lost
– Sundowning – confusion and restlessness in the late afternoon/evenings
– Repetitive actions – nonstop motions, repeating questions
– Anxiety/agitation – constant worrying, restlessness
– Suspiciousness – belief family members are imposters
– Hallucinations – seeing or hearing things that aren’t real
– Resisting care – refusing to bathe or take medication
– Sexual behavior – inappropriate sexual speech/touching
– Apathy – lack of interest and withdrawal
– Depression – tearfulness, hopelessness
– Sleep issues – up at night, napping during the day
The right combination of medical treatment, caregiver support, and home environment adaptations can help minimize disruptive behaviors in Alzheimer’s.
Are Alzheimer’s Behaviors Intentional?
No, inappropriate behaviors in people with Alzheimer’s and dementia do not stem from intentional defiance or spite. They are caused by:
– The progressive death of brain cells
– Breakdown of neuropathways controlling inhibition, personality, and regulation of emotions/impulses
– Memory loss leading to confusion, disorientation, and frustration
– Loss of ability to communicate needs
– Stress and fatigue exacerbating symptoms
The person is not behaving this way on purpose, but literally cannot control it due to how Alzheimer’s ravages the brain. Educating caregivers and family on this concept helps avoid viewing behaviors as deliberate. While behaviors can seem rude or needlessly disruptive, understanding their root cause in a damaged brain encourages patience and compassion.
Preventing Inappropriate Behaviors
While difficult dementia behaviors cannot be entirely prevented, some proactive strategies to minimize them include:
– Providing structured routines to ease anxiety
– Reducing noise/clutter in the home environment
– Ensuring regular exercise and activities
– Managing pain, hunger, fatigue that can exacerbate behaviors
– Using memory aids like calendar, signs, sticky notes to improve orientation
– Keeping the person engaged in hobbies, crafts, music
– Helping the person feel calm and reassured
– Providing ample supervision and removing hazards
– Working with a doctor to manage medical issues and medication side effects
– Getting caregiver counseling/support to prevent burnout
The goal should be creating stability, structure, and a patient atmosphere to limit confusion and other Alzheimer’s symptoms that can trigger behaviors.
When to Seek Medical Help for Behaviors
See a doctor promptly if Alzheimer’s behaviors:
– Pose danger to self or others
– Prevent essential care like eating, bathing, and sleeping
– Indicate possible psychiatric illness like severe depression
– Result from new medication causing side effects
– Are accompanied by cognitive/physical decline
A medical assessment can identify if there are underlying issues or needs to change medication regimen. The doctor may prescribe something for anxiety, depression, or aggression/agitation in order to calm disruptive behaviors. They can also refer to behavioral health specialists if needed. Don’t wait to seek help – challenging behaviors often escalate without medical intervention.
Supporting Caregivers of People with Alzheimer’s Behaviors
Caring for someone with difficult Alzheimer’s behaviors takes immense patience and resilience. Supporting these family caregivers is vital:
- Provide education on the biological causes of behaviors to avoid viewing them as intentional.
- Teach caregivers coping techniques like redirecting, distraction, and validating feelings.
- Encourage regular respite so caregivers get breaks to reduce burnout.
- Refer caregivers to counseling/support groups to process challenges.
- Help set up home safety measures like alarms on doors if wandering is an issue.
- Assist with arranging medical follow up for assessment of behaviors.
- Check on caregiver emotional health and watch for signs of depression or anxiety.
- Provide info on care resources like in-home help, adult day programs, facility care.
Support from professionals, friends, and family is essential for caregivers to manage the stress of Alzheimer’s behaviors without sacrificing their own health and wellbeing.
Conclusion
While Alzheimer’s disease itself does not directly cause inappropriate behaviors, it damages the brain in ways that lead to disinhibition, poor judgement, and difficult dementia symptoms. Aggression, wandering, sexual behavior, repetition, apathy and other behaviors are products of erosion of memory, personality, and behavioral regulation in the brain. Understanding the biological factors causing behaviors can help reduce viewing them as intentional. With proper medical treatment, environmental adaptations and support, many troubling behaviors in Alzheimer’s can be effectively managed to improve quality of life.