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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 is very restless, cannot stay still, or is easily agitated.

Common responses: Something is bothering him; he does not have anything to do.

Alzheimer's interpretation: As the disease progresses, agitation and restlessness commonly accompany the insecurity created by the person's diminishing abilities to cope. Denial and rationalization, which previously helped to block out awareness of functional losses, become less successful protection devices as his problem becomes more pronounced.

Some restlessness may suggest anxiety and underlying fears, though the person cannot always explain these feelings. Too much stimulation can contribute to anxious and agitated behavior. Medication given to control these symptoms should be carefully monitored, as it can sometimes intensify the symptoms it was prescribed to decrease.

Helpful responses

•Use a calm, reassuring approach that supports his feelings, even when the underlying source is not apparent.

•If he can say what is bothering him, try to eliminate the source of trouble; if he cannot, avoid pressing for explanations.

•Reduce noise and activity levels.

•Ask the physician if the agitation can be decreased with medication or if medication might be creating the undesired effects.

•Involve the person in an activity that helps burn off excess energy.

Behavior: The person constantly watches you and follows you around.

Common responses: She wants too much attention; she is overly dependent; she will not entertain herself; she is suspicious and distrustful of you.

Alzheimer's interpretation: This problem develops from the fear and insecurity caused by the person's memory impairment; watching or following the caregiver provides greater security. Such behavior also promotes her sense of belonging and alleviates her sense of isolation, which might otherwise intensify anxiety and fear.

Mistrust or suspiciousness may develop because the person is less sure of what is happening. Her interpretations of information and her reasoning are less reliable. Some persons develop paranoia or more intense suspiciousness as a response to a more threatening world outside themselves.

Helpful responses

•Understand such behaviors as a search for security.

•Identify and alleviate specific fears that are creating insecurity, for example, the fear that you are leaving the house.

•Orient her as to what is happening and clarify what you are doing.

•Spend time with the person.

•Engage her in constructive activity; ask her to do some supervised things with you.

•Avoid dramatic changes in routine.

Behavior: The person's moods change for no apparent reason. He gets upset and even aggressive if cornered.

Common responses: The changes are related to medication, changes in his condition, or something you have done; he is losing his mind and cannot control his emotions.

Alzheimer's interpretation: Such mood swings are often related to changes in the body and brain as the disease progresses. The mood swings also can be precipitated by thoughts and ideas the person has but is unable or unwilling to express.

The person may also be experiencing a catastrophic reaction, which means that the person is overwhelmed by too much happening too quickly, has become extremely upset by his confusion and loss of control, and cannot respond adequately to the situation.

Helpful responses

•Consult a physician if significant mood swings occur without cause or are increasing in intensity.

•Remove the person from the upsetting situation slowly and quietly.

•Be realistic in your expectations and avoid pushing.

•Reduce outside stimulants.

•Avoid expressing anger and frustration.

•Avoid reasoning or arguing, but use nonverbal support such as holding hands in a calming fashion.

Behavior: The person refuses to bathe and groom; she says she has already done so.

Common responses: She does not care about her personal appearance; she is being stubborn and uncooperative; she is lying.

Alzheimer's interpretation: Regular bathing and attention to personal hygiene lose their social significance for persons with brain impairment. Social judgment and awareness diminish. Since taking care of personal hygiene is the most basic sign of independence, however, it becomes threatening to adults to become dependent upon someone's help to bathe and groom themselves.

Bathing can become embarrassing to the brain-impaired person. Being nude, closed in, and helpless in a bathtub or shower creates a sense of vulnerability that may be frightening.

Because the person is accustomed to bathing regularly, it may make perfect sense in her mind to claim she has bathed.

Helpful responses

•Maintain bathing and grooming at regularly scheduled times.

•Make bathing and grooming comfortable and relaxing experiences; offer, for example, a warm bath and relaxing back massage.

•Be aware of potential fears such as anxiety about falling or water that is too hot.

Behavior: The person fails to recognize familiar persons, places, and things.

Common responses: He is getting much worse and is terribly confused.

Alzheimer's interpretation: Due to the kind of brain impairment known as agnosia, the person is gradually losing his function of recognition. What his eyes see no longer can be put together into the previously meaningful and understandable picture. Thus people, places, and things he has been around all his life now truly appear unfamiliar.

Helpful responses

•Avoid arguing when this occurs, as conflict will increase the person's confusion and fear.

•Agree that things look different and calmly indicate who you are or identify the thing in question.

•Bring specific and recognizable things to the person's attention to help reestablish contact with the past.

•Avoid rushing the person.

Last updated February 12, 2009
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