•  Communicating With Someone Who Has Alzheimer's •  Dealing Positively With Alzheimer's Behaviors: Part II •  Dealing Positively With Alzheimer's Behaviors: Part III •  Dealing Positively With Alzheimer's Behaviors: Part IV •  Dealing Positively With Alzheimer's Behaviors: Part V

Alzheimer's disease causes the brain to deteriorate, causing severe memory loss, confused thinking, and personality changes. As a result, many caregivers find their loved one's behavior can be perplexing, frustrating, and difficult to deal with. But if you understand why the patient is acting in a certain way, you'll be more likely to respond with skill and patience. These step-by-step guidelines are reprinted with permission from Alzheimer's: A Caregiver's Guide and Sourcebook (John Wiley &Sons, 1992) by Howard Gruetzner.

Behavior: The person asks the same questions over and over.

Common responses: The person is not listening or trying to remember; she wants attention or is trying to annoy you; she should be able to control this.

Alzheimer's interpretation: The person is suffering memory loss, which in turn creates a strong sense of insecurity and uncertainty. She may be asking the same questions repeatedly because she seeks reassurance and security, or perhaps your earlier answers seemed vague or unclear. She may sense you are avoiding the answer, which could heighten her sense of insecurity.

In more advanced stages, memory impairment may be so severe that she does not recall asking the question, or she may feel threatened by your earlier answer. For example, if she asks repeatedly when she is going to the doctor, the doctor may be a source of insecurity for her.

Helpful responses

•Respond clearly, slowly, and concretely to questions.

•Have the person repeat what you have said.

•If you suspect that your earlier answer disturbed the person, provide reassurance and/or factual information that will set her mind at rest.

•Distract the person into other activity or other topics of discussion and ignore further questions.

•Avoid arguing or responding with anger, do not rebuke the person for the memory problem.

•Write down the information in question for the person who can still read.

Behavior: The person's personality appears to have changed.

Common responses: He is going crazy or having a nervous breakdown; he has lost all self-respect and pride.

Alzheimer's interpretation: Personality changes are characteristic symptoms of Alzheimer's. Often, these changes are observed prior to any clear impairment of memory or intellectual abilities. Brain impairment associated with Alzheimer's can radically change the way the person acts. Additionally, personality characteristics can be exaggerated in early phases of the illness.

Subtle changes in personality can represent an early signal that a problem exists. If the person realizes that he is acting in ways which are not like him, he may fear that he is having a nervous breakdown or losing his mind.

Eventually the brain impairment erases most traits of individuality. Some examples of personality changes follow:

Helpful responses

•Accept personality as result of, or reactions to, brain impairment.

•Try to satisfy the needs underlying behavior, such as the person's need for security, self-esteem, dignity, and love.

Behavior: The person does not do what she says she will or leaves task uncompleted.

Common responses: She is lazy and not really trying; she is lying to you; she wants your help with everything.

Alzheimer's interpretation: Memory impairment makes it more difficult to do something that was agreed upon. For example, seeing a shirt laid on the bed may no longer trigger the idea that the person should put it on. Memory abilities cannot be separated from intellectual abilities, such as reasoning, and both faculties are being lost.

Helpful responses

•Use reminders and memory lists.

•Maintain a routine for daily activities.

•Make requests close to the time the task is to be completed.

•Provide step-by-step assistance for more complicated tasks.

•Always request the desired behavior in the same setting (e.g. bathroom).

•Provide verbal assistance if the person seems to have forgotten how to complete parts of the task or has forgotten what she is doing.

Behavior: The person denies his memory problems and makes excuses for mistakes, blames others, or seems unaware of the problem.

Common responses: The person is not being honest; he should face the problem and accept responsibility for his own mistakes; he is just getting old and senile.

Alzheimer's interpretation: Denial of memory problems is a very common response to Alzheimer's. Initially, denial is a necessary defense. It protects the person from frightening changes that are difficult to accept. If he makes excuses or blames other, he may be desperately trying to explain the memory impairment without directly confronting the problem.

Helpful responses

•Avoid forcing the person to face up to the memory problems.

•Provide reminders or suggest checklists as ways to aid memory

•Be understanding of the threat that memory impairment poses for your relative.

•Arrange for the person to talk to a professional if he seems troubled but cannot admit the problem to his family.

Behavior: The person insists she does not need help because she has always done things for herself; she becomes angry when you offer assistance.

Common responses: She is stubborn and unreasonable; she is rejecting you personally; her anger is unfair.

Alzheimer's interpretation: The person's refusal of help is an effort to maintain independence. Anger directed toward you may really be caused by her frustration with the illness. Her self-worth and self-esteem are threatened. Later, such denial may show she has lost a grasp of her own needs and problems.

Helpful responses

•Determine what help is needed and provide what is needed in a kind manner.

•Realize that the person may genuinely lack awareness of her needs and problems.

•Provide encouragement and reinforcement for even the smallest success and for acceptance of your help.

•Avoid overemphasizing the person's weaknesses or communicating disgust.

•Avoid confronting problems too directly if you suspect the confrontation could provoke strong emotional reactions.

First published July 27, 2000
Last updated March 6, 2008

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