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(Ed.note: during July and August, CNN will be addressing several of the questions that come up repeatedly in our support groups. Share your comments or suggestions, or let us know what questions or concerns you would like for us to cover in future issues, by emailing network@memorycare.org)
My husband is in early-stage Alzheimer's Disease. He has always been easy to get along with but is now uncooperative, argumentative, and just downright mean. Is this due to the disease or to his medications?
More than likely, it's due to the disease. Personality changes are very common in persons with dementia, and while many of them are minor, others are upsetting both to the individuals as well as their caregivers. Unusual behaviors such as shouting, cursing, striking or pushing someone away, refusing food or social outings, refusing to bathe or change clothes, resisting medications, wandering, etc., cannot be ignored, and families must learn the best ways to manage them.
Violent behavior or physical aggression must be dealt with at once to prevent injury. Medications in the form of sedatives, tranquilizers, anti-depressants, or antipsychotics are commonly prescribed for behavioral problems, but this must be done with care. Some medications are not well tolerated by people with cognitive disorders, and can sometimes make the situation worse. Talk openly with your loved one's physician to be sure that such medications are warranted, and be aware of any common side-effects that may arise.
Before taking the pharmacological route, however, you might try a different strategy. People in early stages of dementia are losing their ability to communicate well and to understand and process what's happening to them. They are usually confused, frustrated, and frightened, and will often lash out at the people closest to them. Many are not able to put this into words, so they end up "showing" how they feel instead. One son said of his father's outbursts, "It looks like Dad, it sounds like Dad, but it doesn't act like Dad." In many instances, what comes across as a mean or aggressive act could simply be a cry for help.
So while you may be tempted to react strongly to your husband's behavior, a better response would be to try and seek out what's beneath it. Remember that he has a disease that is causing him to act this way. Sometimes a simple act of loving reassurance can diffuse his anger, or at least keep it from escalating. Then examine what's been going on around him that might be causing his agitation. Has there been a lot of activity that day, or more people than usual? Have there been changes in his routine? Is he dehydrated or constipated, or in some other physical discomfort? Is he sick? Urinary tract infections are very common in people with incontinence, and will cause all manner of behavioral problems. Is he bored, scared, or lonely? Has he taken too much or not enough of his regular medications? Is he sleeping?
Remember that your goal is not to reason with him or explain what's happening. This will likely frustrate him even more, because he will not understand you. Resist the urge to use too many words. Don't try to negotiate or talk him into anything. And above all, stay calm. Your agitation will feed his. If he's not receptive to your approach, back off and try again later. You'd be surprised what a difference an hour can make.
It will take some time before you're able to identify the root of some of your husband's behavior, but learning to look beyond it to what he is actually expressing is an important first step. Unfortunately, there are some symptoms of this disease that we will never understand. Although it's difficult to know just what to say in the face of angry or hurtful words, you can never go wrong by simply reassuring him that he is still loved.
Why does my wife follow me everywhere I go? I can't even go to the bathroom without her coming along!
Simply put, your wife is afraid. When you are not with her, she forgets where you are, or even where she is. She doesn't know what she should do. You have become her anchor, her assurance that all is well, and when she can't see you, she becomes frightened. Keep in mind that the world of an Alzheimer's person is distorted. She doesn't see as well, her brain doesn't understand or process like it used to, and she feels like she is lost much of the time.
You have already discovered that it does no good to say, "I'll be right back," because she ends up following you anyway. And telling her "I'm just in the next room," is of little comfort to her because she forgets it seconds after you say it. The bottom line is, she wants to be where you are.
So how do you keep from going nuts? Try occupying her with something in the same room with you. For example, if you're working in the kitchen, give her something to do (sorting silverware or plastic containers, or folding napkins) that she can do at the kitchen table, out of your way (and unless you're sure she can handle it, choose a task that doesn't involve her using a knife or other sharp instrument!). In the laundry room, give her some towels to fold. While you mow the grass, have her sit outside (where she can see you) and deadhead a pot of flowers. And so on. Usually, as long as she can see you, she should be OK.
As for getting a bit of privacy for yourself, try to schedule showers, etc. after she's already gone to bed, or before she wakes up. Consider hiring a daytime sitter a few hours each week to give yourself a break - and don't say "She won't let anyone besides me look after her" because she will. Really.
Understand that you are now your wife's caretaker in every sense of the word. She is dependent upon you not only for physical needs such as food, shelter, and personal hygiene, but also for emotional needs - you are her connection to the world, the one person she knows and trusts. In a world that is frightening to her, she needs constant reassurance that she is safe. Your presence provides that reassurance. Until someone else can too, she's going to continue to be your shadow.
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