Web Med http://www.webmd.com/alzheimers/guide/managing-unpredictable-behavior
Alzheimer's Disease: Managing Unpredictable Behavior in
Alzheimer’s behavior management 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.
Following are some tips to help you manage the changes in thinking and behavior that often
accompany Alzheimer's disease:
Maintain. 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.
Stay the course. Try to minimize any changes in the surroundings or to your loved one's
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
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 good 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
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.
In some cases, behavioral problems (especially physical aggressiveness and delusions) may
require treatment with medications, such as anti-anxiety or anti-psychotic drugs. However, these
drugs can have negative side effects, including drowsiness and depression, and can further affect
Reviewed by the doctors at the The Cleveland Clinic Neuroscience Center.