3 Types Of Behavioral Triggers In Alzheimer’s Disease

What Is Alzheimers Disease

Alzheimers disease is a brain condition that causes a progressive decline in memory, thinking, learning and organizing skills. It eventually affects a persons ability to carry out basic daily activities. Alzheimers disease is the most common cause of dementia.

The symptoms of Alzheimers worsen over time. Researchers believe the disease process may start 10 years or more before the first symptoms appear. AD most commonly affects people over the age of 65.

What is the difference between Alzheimers and dementia?

Dementia describes the state of a persons mental function. Its not a specific disease. Its a decline in mental function from a previously higher level thats severe enough to interfere with daily living.

A person with dementia has two or more of these specific difficulties, including a change or decline in:

• Dementia due to Parkinsons disease.

What Causes Early Onset Alzheimer’s

Getting an accurate diagnosis of early-onset Alzheimer is difficult since health care providers generally do not look for the disease in younger people. There may be conflicting diagnoses from different health care professionals and symptoms may be wrongly attributed to stress.

Doctors don’t understand why most cases of early-onset Alzheimer are seen at such a young age. In a few hundred families worldwide, scientists have identified several rare genes that cause Alzheimer is. People who inherit these rare genes tend to experience symptoms in their 30s, 40s and 50s.

Many family members in multiple generations are affected by Alzheimer’s disease because it is caused by deterministic genes.

There are 5 million people in the United States who have Alzheimer’s disease. Alzheimer’s disease that affects your ability to think and remember.

It is known as early onset Alzheimer, or younger-onset Alzheimer, when it happens in someone before they reach the age of 65. 5 percent of people with Alzheimer is disease will develop symptoms of early Alzheimer is.

You can learn more about the risk factors and how to handle a diagnosis of Alzheimer’s disease.

Early-onset and late-onset Alzheimer’s are the two types of the disease. There is a genetic component to both types of Alzheimer’s disease.

Rummaging And Hiding Things

Caring for a patient who rummages around or hides things in the home can be a challenge, but not an insurmountable one.

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What Is The Treatment For Alzheimers Disease

Theres no cure for Alzheimers disease, but certain medications can temporarily slow the worsening of dementia symptoms. Medications and other interventions can also help with behavioral symptoms.

Beginning treatment as early as possible for Alzheimers could help maintain daily functioning for a while. However, current medications wont stop or reverse AD.

As AD affects everyone differently, treatment is highly individualized. Healthcare providers work with people with Alzheimers and their caregivers to determine the best treatment plan.

The U.S. Food and Drug Administration has approved two types of drugs to treat the symptoms of Alzheimers disease:

• Cholinesterase inhibitors.
• NMDA antagonists.

The FDA has given accelerated approval for aducanumab , the first disease-modifying therapy for Alzheimers disease. The medication helps to reduce amyloid deposits in your brain.

Aducanumab is a new medication, and researchers studied its effects in people living with early Alzheimers disease. Because of this, it may only help people in the early stage.

Cholinesterase inhibitors

The following cholinesterase inhibitors can help treat the symptoms of mild to moderate Alzheimers disease:

• Donepezil . This is also FDA-approved to treat moderate to severe AD.

These drugs can improve some memory problems and reduce some behavioral symptoms of Alzheimers disease.

These medications dont cure Alzheimers disease or stop the progression of the disease.

NMDA antagonists

Clinical trials

Who Does Alzheimers Disease Affect

Alzheimers disease mainly affects people over age 65. The higher your age over 65, the more likely youll develop Alzheimers.

Some people develop Alzheimers disease before age 65 typically in their 40s or 50s. This is called early-onset Alzheimers disease. Its rare. Less than 10% of AD cases are early-onset.

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Aggressive Behavior In Memory Care / Assisted Living

The staff in an assisted living home for people with dementia should be uniquely capable at handling aggression in people with dementia. In fact, how a memory care community handles residents who have issues with aggression is a good gauge of whether its the right place for your loved one. If staff seem annoyed by aggression, or disdainful, then they arent good for mom or dad.

To know if a memory care home can handle your loved one with dementias aggression issues, look for these signs: Staff gets to know residents, becoming like friends. If they form a connection or bond to residents, employees at memory care homes will have a better understanding of what triggers aggression and how to cool it down. Communication with loved ones outside the community is encouraged. A memory care home that handles aggression well will want loved ones to be accessible. They should take your phone number so you can be reached quickly to help if the person with dementia decides they need to speak with you. Incidents of aggressive behavior should be documented in reports. This can identify causes of outbursts, and show patterns unique to individuals.

Ask about training. Is there regular training and continuing education for employees, and do they learn techniques to deal with aggressive behavior in residents?

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Dealing With Nighttime Wakefulness And Pacing

If your loved one paces at night, make sure they have a safe room in which to do so, or have another caregiver take over at night. You need your rest, too. In the later stages of Alzheimers, you may want to consider a hospital bed with guardrails.

Some dementia patients have difficulty getting or staying asleep because they arent responding to day and night transitions. Adding bright light exposure during the day and melatonin supplements at night may help to improve their sleeping patterns.

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Common Changes In Behaviour

In the middle to later stages of most types of dementia, a person may start to behave differently. This can be distressing for both the person with dementia and those who care for them.

Some common changes in behaviour include:

• repeating the same question or activity over and over again
• restlessness, like pacing up and down, wandering and fidgeting
• night-time waking and sleep disturbance
• following a partner or spouse around everywhere
• loss of self-confidence, which may show as apathy or disinterest in their usual activities

If you’re caring for someone who’s showing these behaviours, it’s important to try to understand why they’re behaving like this, which is not always easy.

You may find it reassuring to remember that these behaviours may be how someone is communicating their feelings. It may help to look at different ways of communicating with someone with dementia.

Sometimes these behaviours are not a dementia symptom. They can be a result of frustration with not being understood or with their environment, which they no longer find familiar but confusing.

Don’t Forget To Take Care Of Yourself

Caregiving for a loved one with dementia can be extremely demanding and stressful. Each day can bring more challenges and higher levels of anxiety, often without any signs of appreciation from the person you’re caring for. Taking care of yourself and getting help and support is essential for both your well-being and your loved ones quality of life.

Respite care can provide a break to help you relieve stress and restore energy. Make use of any services available to you and ask for help from family members. It can make all the difference to your success as a caregiver and the well-being of your patient.

• References

  Neurocognitive Disorders. . In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association.

  American Psychiatric Association. . Neurocognitive Disorders. In Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association.

  Brodaty, H., & Donkin, M. . Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217228.

  Grossberg, G. T., & Desai, A. K. . Management of Alzheimers Disease. The Journals of Gerontology: Series A, 58, M331M353.

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Ways To Keep Your Loved One Calm

Once you have an idea of what might be behind the aggression, make a plan and see if it helps. If your first plan doesnât work, try another one. You might need to try several things, and no one plan is likely to always work.

If nothing seems to help, talk to a doctor or counselor for advice.

For aggression triggered by contact with you or other people:

Speak as softly and as calmly as you can, even if you feel frustrated, angry, or sad. If you need to and it’s safe, step away for a few minutes and take some deep breaths.

• Try to comfort your loved one instead of telling them they’re wrong, even if what they’re saying isnât true.
• Be as patient and as understanding as possible.
• Donât point out what they’re doing wrong — that can make things worse.
• Be clear about what you’d like them to do instead of telling them what not to do. For example, say “Let’s sit in this chair,” instead of “Stay out of the kitchen.”

For aggression that happens during things like bathing, dressing, toileting, or eating:

• Break the activity into simple steps and give one or two directions at a time.
• Go slowly and don’t rush them.
• Explain what you’re going to do before you do it, especially before you touch them.
• Give them simple choices.

For aggression triggered by their surroundings or routine:

Types Of Medication For Difficult Behaviors In Dementia

Most medications used to treat difficult behaviors fall into one of the following categories:

1. Antipsychotics. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms.

Commonly used drugs: Antipsychotics often used in older adults include:

• For a longer list of antipsychotics drugs, see this NIH page.

Usual effects: Most antipsychotics are sedating, and will calm agitation or aggression through these sedating effects. Antipsychotics may also reduce true psychosis symptoms, such as delusions, hallucinations, or paranoid beliefs, but its rare for them to completely correct these in people with dementia.

Risks of use: The risks of antipsychotics are related to how high the dose is, and include:

• Increased risk of falls
• Increased risk of stroke and of death this has been estimated as an increased absolute risk of 1-4%
• A risk of side-effects known as extrapyramidal symptoms, which include stiffness and tremor similar to Parkinsons disease, as well as a variety of other muscle coordination problems
• People with Lewy-body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects in such people, quetiapine is considered the safest choice

2. Benzodiazepines. This is a category of medication that relaxes people fairly quickly. So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia. They can easily become habit-forming.

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Education About Genetic Causes Of Eating Behavior Found To Affect Attitudes Toward People With Higher Weight

by Elsevier

Journal of Nutrition Education and Behavior

Education about gene-by-environment interaction causes of eating behaviors can have beneficial downstream effects on attitudes toward people with higher weight. A recent study included in the Journal of Nutrition Education and Behavior found that participants who received education about G X E concepts reported higher empathy and held fewer stigmatizing attitudes toward individuals with higher weight. G X E is when two different genotypes respond to variations in the environment in two different ways.

“Discriminatory attitudes against people with higher weight have been observed at comparable rates to racial and gender discrimination and are often more overt because weight stigma is viewed as a more socially acceptable form of negative bias,” says corresponding author Susan Persky, Ph.D., Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.

“However, weight has a sizable genetic component. Our study found that increasing education about the role of genetics in eating behavior may therefore help to alleviate weight stigma by reducing the extent to which individuals are blamed for their weight.”

Journal of Nutrition Education and BehaviorMore information:Journal of Nutrition Education and BehaviorJournal information:

What Are The Signs And Symptoms Of Alzheimers Disease

The signs and symptoms of Alzheimers disease vary based on the stage of the condition. In general, the symptoms of AD involve a gradual decline in some, most or all of the following:

• Understanding visual form and space relationship.
• Behavior and personality.

People with memory loss or other signs of Alzheimers may have difficulty recognizing their mental decline. These signs may be more obvious to loved ones. Anyone experiencing dementia-like symptoms should see a healthcare provider as soon as possible.

Symptoms of the mild stage of Alzheimers dementia

Symptoms of AD become noticeable in the mild stage. The most common early symptom is forgetting newly learned information, especially recent events, places and names.

Other signs and symptoms of mild Alzheimers include:

• Having difficulty finding the right words to express thoughts.
• Losing or misplacing objects more than usual.
• Having difficulty making plans or organizing.
• Having difficulty problem-solving.
• Taking longer to complete routine daily tasks.

Most people in the mild stage of AD have no problem recognizing familiar faces and can usually travel to familiar places.

Symptoms of the moderate stage of Alzheimers

Moderate Alzheimers is typically the longest stage and can last many years. People in the moderate stage of Alzheimers often require care and assistance.

People in this stage may:

Symptoms of the severe stage of Alzheimers

In the severe stage of Alzheimers disease, the person often:

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Measurement Of Behavioral Changes

The Brief Agitation Rating Scale74 is a 10-item scale to quantify agitation. It has good interrater reliability and validity and is easy to use on a regular basis. Measurement is especially important in long-term care settings where patients with advanced dementia who are receiving psychotropics need documentation regarding the benefit of drugs. The Neuropsychiatric Inventory75 provides comprehensive assessment of psychopathology in dementia and is usually used in research settings. The Geriatric Depression Scale-1576 was designed to be easier for cognitively impaired people to complete and may be considered in dementia patients to identify comorbid depression.

Five Ways To Help Identify The Causes Of Problem Behavior

Common Causes of Problem Behavior

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Other Factors That Can Affect Behavior

In addition to changes in the brain, other things may affect how people with Alzheimers behave:

• Feelings such as sadness, fear, stress, confusion, or anxiety
• Health-related problems, including illness, pain, new medications, or lack of sleep
• Other physical issues like infections, constipation, hunger or thirst, or problems seeing or hearing

Other problems in their surroundings may affect behavior for a person with Alzheimers disease. Too much noise, such as TV, radio, or many people talking at once can cause frustration and confusion. Stepping from one type of flooring to another or the way the floor looks may make the person think he or she needs to take a step down. Mirrors may make them think that a mirror image is another person in the room. For tips on creating an Alzheimers-safe home, visit Home Safety and Alzheimers Disease.

If you dont know what is causing the problem, call the doctor. It could be caused by a physical or medical issue.

Why Aggressive Behavior Happens

Aggressive behavior is almost always triggered by something. Figure out what that something is and youll both be much happier. If your loved one seems angry and is acting aggressively, check for pain first. Someone with dementia may not know how to express discomfort or pain. To identify the cause of aggression, look for these signs: Stroking or pulling on a particular part of the body. Facial contortions like clenched teeth or inverted eyebrows. Body language, like rocking or pulling away. Appetite change An existing condition like arthritis Dental problems like a toothache Nails that are too long Constipation

Is it a reaction to other people? Is something wrong in the environment? Does the aggressive behavior happen at the same time every day, or in the same place? Maybe a particular person coming to visit will cause your loved one to get upset.

Finding a pattern will help explain, and ultimately manage, your loved ones aggression. One good idea to help is keeping a caregiver diary that lists what was happening when your loved one became angry. Details like time of day, what activities were going on previously or were anticipated, and how exactly the lashing out occurred can be useful in identifying the problem. If you need to see a doctor to address behavior issues, having notes will be helpful for forming a medical opinion. Was the person tired? Uncomfortable? Embarrassed about something?

Physical Causes

Emotional Causes

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