First Aid Mental Health

Behavioral and Psychological Consequences of Alzheimer’s Dementia

It was almost close to midnight when I received an unexpected call. A casualty officer was at the other end of the line.

“Mike, we need your help. RCMP just brought an elderly who destroyed the door and broke some of the appliances. . . Apparently, the patient’s behavior has gotten worse lately. . .”

As I was driving to the hospital, I was already thinking about diagnostic possibilities. Alzheimer’s dementia was certainly at the top of my list. In any elderly with no prior psychiatric disorder and has gradually become aggressive, dementia is a well-known culprit.

Perhaps you’d wonder why I specifically thought about it as opposed to other possible illnesses.

Why not? Alzheimer’s dementia has a combination of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor activity problem, and impairment in executive functioning (e.g. problems in planning, abstract reasoning, and organizing).

These cognitive deficits, especially recent memory impairment, are the frequent complaints and the most noticeable in the early phase.

As the disease advances, cognitive decline becomes associated with behavioral and psychological changes.

What are the behavioral manifestations of dementia?

Individuals with dementia develop agitation, verbal outbursts, repetitive behavior, wandering behavior, aggression, or violence. Agitation can be shown by pacing back and forth, restlessness, and inability to sit still.

Verbal outbursts consist of day-long screaming or occasional yelling even without any provocation. Repetitive behavior can be manifested by opening and closing a closet, a purse, or a drawer. Asking questions repetitiously—for instance about an important event, a medical appointment, or a TV schedule—is common.

Wandering can happen especially at the late stages of the illness. Several reasons can justify this behavior. Some feel that they have “to go home” when in fact they’re home. Others believe that they have to look for their children or spouses as they can’t anymore recognize them. Some channel their unused energies by walking aimlessly.

If doors are left unlocked, some of them wander away from their homes. Hence, safety becomes an issue especially in winter when they forget to wear the appropriate attire.

Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. For instance, a gentleman punched a hole on the wall with his cane and smashed the window with a chair. I’ve seen individuals who are threatening to hurt or kill loved ones at the height of their frustrations. Others are not only physically aggressive but are also verbally abusive toward their spouses.

What are the psychological changes associated with dementia?

The major psychological syndromes associated with Alzheimer’s include depression, anxiety, delusions, and hallucinations.

Depression in dementia is common and can occur even in the early or mild phase of the illness. Up to 87% develop depression. Aside from feelings of sadness, they also experience crying episodes, irritability, thoughts of death, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, and poor energy.

About 50% of demented individuals show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble. I’ve seen individuals who believe that they are still working or that they are students when in fact they have been retired for at least 10 years.

Moreover, many individuals with dementia may experience hallucinations. These hallucinations are mainly visual — seeing strangers in the house, an animal or insects in the living room, or people in the bedroom or behind the TV set. Occasionally, auditory hallucinations may be experienced — hearing footsteps, knocks on the door, or even people singing church hymns.

Although difficult to deal with, most of these behavioral and psychological consequences of dementia can be treated especially if recognized and addressed early.

About the Author:

Dr. Michael G. Rayel — author, game inventor, and psychiatrist — has created the Oikos Game Series to promote emotional health. Since 2005, he has published Oikos’ Insights! www.oikosinsights.com— an online resource for personal development. Suggest a topic at www.oikosglobal.com.