Alzheimer's disease can cause a person to exhibit unusual and unpredictable behaviors that challenge caregivers. Some of the behaviors which caregivers find most troubling are repetitive questions, wandering, nighttime restlessness, agitation, combativeness, incontinence and accusations of theft. These behaviors can lead to frustration and tension, for both the person with Alzheimer's and their caregivers. It is important to remember that people afflicted with Alzheimer's are not acting in a difficult way on purpose. The best strategies for coping with the challenging behaviors are to stay calm, be understanding, patient and flexible.

Please see caregiver challenges subtopics for more information.

Difficult behaviors are generally triggered by many factors. These can be medical problems, frustration at doing tasks that are too difficult, confusing environments and communication breakdowns.  

Health Problems

The first thing to check is whether there is a medical problem. Difficult behavior can be caused by conditions like dehydration, fatigue, constipation, reactions to medication, a urinary tract infection or some other acute illness. Because we can't rely on the impaired person to tell us what's wrong, it is important to be alert to problems and take the person to their physician if their behavior suddenly worsens. In many cases, the cause is treatable.

Difficult Tasks

Unfamiliar or especially complicated tasks can be frustrating and trigger difficult behaviors. For instance, a person may become overwhelmed and upset when you ask him to get dressed. Instructions that break a task down, step by step are most likely to be successfully completed without causing unnecessary frustration or dismay.

Confusing Environments

Crowded, unfamiliar, busy or noisy surroundings can be very distressing to the person with dementia. Optimal environments are familiar, simple, have adequate light and lots of cues to orient the person. For example, bathrooms should be clearly marked so they can be readily located. You may notice more difficult behaviors when the patient goes to a new place or when you have visitors who upset the routine.  Click here to see more information on Environments.

Communications Breakdowns

Many people afflicted with dementia have difficulty speaking and understanding what is said to them. To improve communication, go to a quiet location, speak slowly and simply, and use many cues (like pointing to the bathroom when you ask if it is needed).  Click here to see more information on Communication.

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Despite our best efforts, troublesome behaviors are likely to arise. When they do, there is a three-step technique to help you manage them: (1) Identify the Behavior; (2) Understand its Cause; (3) Adapt.  

Step One: Identify the Behavior

Identify the behavior that needs to be managed. Although this may sound very obvious, it is not always easy. The following are questions you can ask that will help identify the behavior.

• Is it observable?
• Is it measurable?
• Can others see it?

Step Two: Understand the Cause

Most behaviors have a cause or “trigger.”  Ask:

• What is the feeling underlying the behavior?
• When and where does the behavior occur?
• What happens before it?
• Who is there when it occurs?
• Is it triggered by a medical factor? A difficult task? An environmental factor?
• Is there a communication breakdown?

Step Three: Adapt

Since the person with Alzheimer's disease is unable to make sense of or change his behavior, it is up to the caregiver to adapt and make changes that will help manage the situation.

Below are some adaptation strategies that other families have found helpful.

• When problems arise try to distract the individual with an enjoyable activity.
• Be reassuring and calm. Don't argue. Remember that you set the tone.
• Respond to the emotions underlying the behavior.
• Identify health problems as quickly as possible and get them treated.
• Keep your home environment simple.
• Use strategies that orient the patient, like a night light in the bathroom.
• Decide whether the "difficult" behavior is a problem for you or the individual with dementia. Some annoying behaviors are best accepted, as long a safety isn't an issue.

Sources: Articles from the Orange County Chapter of the Alzheimer's Association, “Understanding Difficult Behaviors” by Debra Cherry, Ph.D. and Wendy Carr and © 2003 Alzheimer's Disease and Related Disorders Association, Inc. 

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