Q. My loved one is abusive, throws things and curses at me all the time. How do I handle this behavior?
A. People with Alzheimer’s disease tend to experience confusion and disorientation, which can influence their perception of reality. If their judgment is impaired, they may have trouble distinguishing right from wrong, and it’s not uncommon for them to take their aggression out on even the closest family members. Their confusion can appear in many ways, such as attacking caregivers because they no longer recognize them or negatively associate them with someone from the past.
First and foremost, you should discuss this behavior with the person’s primary care physician. There may be a treatable medical problem, such as a urinary tract infection or dehydration, which could be worsening the symptoms of Alzheimer’s disease and contributing to aggression.
Cursing and throwing things are common ways for people with Alzheimer’s disease to express their agitation. While your initial response may be to yell and try to get to the bottom of this behavior, the truth is that people with Alzheimer’s disease may not be able to express why they are upset. Often times, it is because of this inability to express their feelings or discomfort that they become aggressive in the first place.
If your loved one becomes physically dangerous or violent, your first priority should be to assure the person’s safety and your own safety. The key to doing so is to remain calm while providing reassurance. One way to do this is by speaking to your loved one, eye to eye, in a soft tone and reminding the person that you are there to help.
Q. How do I handle sundowning syndrome?
A. Many individuals with Alzheimer’s disease experience increased confusion and agitation in the late afternoon and early evening—a symptom known as sundowning. Most sundowning emerges in the middle stages of the disease and slowly worsens as the disease progresses. Like with other behavioral challenges you may face as a caregiver, it often helps to make changes to the environment, daily routines and the ways you interact with your loved one. Although it is unlikely that any one technique will reverse or completely fix the situation, it is important to carefully consider all options and customize interventions to the specific person and situation.
Concerning the environment, watch for “triggers” that seem to further confuse, frustrate or agitate the person with dementia. For example, excess stimuli and clutter might aggravate sundowning. In addition, it helps to increase indoor lighting before dusk.
Tune in to daily routines that may be causing moments of failure or confusion. It may help to keep your loved one awake during the day, do only simple, calming activities in the afternoon, and make sure the person is well-fed and well-hydrated.
Lastly, in terms of interacting with your loved one, pay special attention to your use of certain words and phrases, body language and tone. Set the tone by modeling the mood and behavior that is appropriate for the situation. Stay calm, offer support and remain focused on positive themes—even if your loved one has a shift toward an unpleasant mood.
Q. How does Alzheimer’s disease affect someone’s sexual experiences?
A. There is no across-the board answer to this question. The way Alzheimer’s disease and related illnesses affects a person’s sexual life can vary, based on such factors as someone’s past sexual history and the stage of the disease.
In the milder stages of dementia, many individuals who were sexually active in the past remain active and continue to enjoy the experience. For others, emotional distress may lead to sexual withdrawal and feelings of inadequacy, or resentment and anger because of sexual difficulties.
As a partner, you can encourage your loved one to discuss his or feelings, emphasize the value of your relationship with or without sexual relations, and, if desired, seek professional counseling.
Later on in the disease process, some individuals with dementia may forget how to make love, may become less considerate of a partner’s needs, and may exhibit inappropriate and aggressive sexual behavior, such as exposing private parts. They may forget that you’ve just engaged in sexual activities and demand more relations, which can lead to anger if denied.
In general, it will be up to you to redefine sexual intimacy and adjust to the physical and emotional changes in your relationship. Even when sexual intimacy is not possible, individuals with dementia need the safety, touch, comfort and security that come from being with a person they trust.
In rarer instances, people with dementia exhibit sexually aggressive behaviors, such as fondling, or at¬tempting or having intercourse with others. These acts of sexual disinhibition result from brain damage, especially in the frontal and temporal lobes of the brain, that has disrupted the individual’s ability to control responses or can be a reaction to unmet needs.
To avoid putting you, your loved one and others at risk, it is important to discuss these issues with a healthcare professional and identify the causes and options for treatment and behavioral interventions.