Alzheimer disease and related dementias can cause a person to act in different and unpredictable ways. Some individuals with Alzheimer’s become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear.

These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to understand that the person is not acting that way on purpose.

Behavior may be related to:

• Physical discomfort: Illnesses or medication
• Overstimulation: Loud noises or a busy environment
• Unfamiliar surroundings: New places or the inability to recognize home
• Complicated tasks: Difficulty with activities or chores
• Frustrating interactions: Inability to communicate effectively

Use this three-step approach to help identify common behaviors and their causes:

• Identify and examine the behavior
  • What was the behavior? Is it harmful to the individual or others?
  • What happened just before the behavior occurred?
  • What happened immediately after the behavior occurred? How did you react?
  • Consult a physician to identify any causes related to medications or illness.
• Explore potential solutions
  • What are the needs of the person with dementia? Are they being met?
  • Can adapting the surroundings comfort the person?
  • How can you change your reaction or your approach to the behavior? Are you responding in a calm and supportive way?
• Try different responses
  • Did your new response help?
  • Do you need to explore other potential causes and solutions? If so, what can you do differently?

Dementia affects each person differently. The Alzheimer’s Association describes five common behaviors with recommended responses:

• Aggression — may be verbal (shouting, name-calling) or physical (hitting, pushing). These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is important to try to understand what is causing the person to become angry or upset.
  
  How to Respond:
  • Try to identify the immediate cause
  • Think about what happened right before the reaction that may have triggered the behavior.
  • Focus on feelings, not facts
  • Try not to concentrate on specific details; rather consider the person’s emotions. Look for the feelings behind the words.
  • Don’t get angry or upset
  • Be positive and reassuring. Speak slowly in a soft tone.
  • Limit distractions
  • Examine the person’s surroundings, and adapt them to avoid other similar situations.
  • Try a relaxing activity
  • Use music, massage or exercise to help soothe the person.


• Anxiety or Agitation — a person with Alzheimer’s may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places of focused on specific details.
  
  How to Respond:
  • Listen to the frustration
  • Find out what may be causing the anxiety, and try to understand.
  • Provide reassurance
  • Use calming phrases. Let the individual know you’re there for him or her.
  • Involve the person in activities
  • Try using art, music or other activities to help the person relax.
  • Modify the environment
  • Decrease noise and distractions, or move to another place.


• Confusion — the person with Alzheimer’s may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The person may also forget the purpose of common items, such as a pen or a fork. These situations are extremely difficult for caregivers and require much patience and understanding.
  
  How to Respond:
  • Stay Calm
  • Although being called by a different name or not being recognized can be painful, try not to make your hurt apparent.
  • Respond with brief explanation
  • Don’t overwhelm the person with lengthy statements and reasons. Instead, clarify with a simple explanation.
  • Show photos and other reminders
  • Use photographs and other thought-provoking items to remind the person of important relationships and places.
  • Offer corrections as suggestions
  • Avoid explanations that sound like scolding. Try "I thought it was a fork," or "I think he is your Grandson Peter."


• Repetition — a person with Alzheimer’s may do or say something over and over again—like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity.
  
  How to Respond:
  • Look for a reason behind the repetition
  • Try to find out if there is a specific cause for the behavior.
  • Focus on the emotion, not the behavior
  • Rather than reacting to what the person is doing, think about how he or she is feeling.
  • Turn the action or behavior into an activity
  • If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
  • Stay calm, and be patient
  • Reassure the person with a calm voice and gentle touch.
  • Provide an answer
  • Give the person the answer that he or she is looking for, even if you have to repeat it several times.
  • Engage the person in an activity
  • The individual may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.
  • Accept the behavior, and work with it
  • If it isn’t harmful, let it be. Find ways to work with it.


• Suspicion — Memory loss and confusion may cause the person with Alzheimer’s to perceive things in new, unusual ways. Individuals may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior.
  
  How to Respond:
  • Don’t take offense
  • Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
  • Don’t argue or try to convince
  • Allow the individual to express ideas. Acknowledge his or her opinions.
  • Offer a simple answer
  • Share your thoughts with the individual, but keep it simple. Don’t overwhelm the person with lengthy explanations or reasons.
  • Switch the focus to another activity
  • Engage the individual in an activity, or ask for help with a chore.
  • Duplicate any lost items
  • If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.