Managing Behavioral Difficulties 

Associated with Dementia

Part 2

 Behavior Problems 

Associated with Physical Illness

Sudden onset changes in mental status can be triggered by numerous medical causes.  Delirium, a condition characterized by sudden onset of increased cognitive impairment, disorientation, attention disturbance, declined consciousness, and perceptual disturbances such as hallucinations, can result from a large number of medical conditions.  Medication effects and infections are two common causes of delirium. (For a more thorough discussion of delirium, refer to the January-February 2001 ACT newsletter in the archive section).  Since delirium can signal potentially life-threatening medical conditions, patients for whom delirium is suspected should always be promptly referred to the physician upon onset of symptoms.  Symptoms of delirium may persist for an extended period of time after the medical cause has been treated.  The delirium can often be managed with anti-psychotic medication.  Environmental management can also help decrease confusion and behavioral disturbances associated with delirium.  Caregivers should attempt to minimize over-stimulation by providing a quiet, soothing atmosphere, consistent scheduling of care activities, and consistency of caregivers.  Quiet, gentle music is preferable to television and can mask some extraneous noises, helping to calm the delirious patient.

Caregivers should also be aware that for patients with Alzheimer’s and related disorders, behavior problems commonly reflect the disease stage.  For example, mood disorders are typical of early stages of Alzheimer’s disease while dependency, anger, suspicions that caregivers are hiding or stealing objects, and suspicions about the nature of domicile (i.e. “take me home” when already at home) are common during middle stages of the disease.  (See “Dementia and Behavior”, November-December ACT newsletter in archives). 

 Auditory and visual impairments can increase the sense of isolation experienced by dementia patients and can contribute to misperceptions of the environment, leading to illusions or hallucinations.  In these cases, hearing aids or hand-held amplifiers, visual aids, and eyeglasses can help. 

Physical discomfort, such as pain, fatigue, hunger, and constipation, can lead to behavior problems in demented individuals who cannot initiate action to relieve discomfort or verbally express discomfort to gain assistance from others.  Caregivers should be particularly alert to behavior problems (i.e. combative behaviors) that occur during personal care tasks as such behaviors can indicate movement related pain due to arthritis, contractures, or other conditions.  In some cases, behavior problems associated with care can be reduced by administration of pain medication prior to personal care.  Sundowning is exacerbated by fatigue and can often be reduced by encouraging mid-day naps.  Since individuals with dementia might “forget” to eat and do not necessarily associate discomfort due to hunger with need to eat, offering snacks throughout the day can often result in decreased behavioral problems.

A final consideration related to physical causes of behavioral problems associated with dementia is that of medication effects and interactions.  Elderly patients are at particular risk for side effects of medications due to decreased efficiency of metabolism resulting in drugs remaining in their systems longer.  Behavioral problems should be discussed with the physician to determine whether prescription or over-the-counter medications might be contributing to behavioral disturbances.

Happy Birthday!!