The symptoms of Alzheimer's disease and other dementias often occur gradually and progress in stages. How quickly the symptoms occur and how quickly patients move from one stage to the next can vary from person to person and with the cause of their dementia.

Early Stage (Stage One)

The early stage of Alzheimer's disease is characterized by mild symptoms and can last two to four years. Often people in the early stage of dementia are aware something is wrong and may even be aware of their diagnosis. It is common for patients in the early stage of dementia to be frustrated by their changing abilities. This may result in depression, anxiety or unpredictable emotions or behaviour.

Typical symptoms of the early stage of Alzheimer's disease include:

• Mild forgetfulness (names, what has been said, recent events)
• Difficulty processing new information (learning new things, following conversations)
• Difficulty concentrating (limited attention span, restlessness)
• Disorientation of time and place (becomes easily lost, trouble following directions, date and time)
• Communication difficulties (finding the right words, using proper grammar, pronouncing words)
• Mild coordination problems
• Increasing inability to do routine tasks
• Mood shifts, depression and fear
• Lack of spontaneity

The middle stage or Stage 2 of Alzheimer's disease brings a further decline in physical and mental abilities. It can last anywhere from two to 10 years. This stage can be a difficult one for the caregiver. Patients in the middle stage will usually need help with many activities including bathing, going to the washroom and dressing. They may tend to wander and become restless. Behaviour can be disruptive, repetitive and even threatening.

Typical symptoms of the middle stage of Alzheimer's disease include:

• Increasing forgetfulness (forget personal history, inability to recognize family or friends)
• Increasing disorientation about time and place
• Personality changes
• Changing moods and emotions (anxious, suspicious, angry, hostile, sad or depressed)
• Changes in behaviour (restlessness and agitation, repetition, aggression, passiveness, wandering, inappropriate behaviour)
• Disrupted sleep patterns
• Require assistance for daily tasks (dressing, bathing, using the toilet)
• Continued language difficulties

A person in the late stage of Alzheimer's disease will need to be cared for 24 hours a day. Patients become bedridden and lose control of their bowels and bladder. Eating and swallowing may become difficult. This stage usually lasts one to three years and ends when the person dies.

Typical symptoms of the late stage of Alzheimer's disease include:

• Loss of ability to remember, communicate or function
• Severe reading, writing and speaking difficulties
• Severe disorientation to time, place and people
• Inability to recognize self or others
• May experience a range of emotions or may withdraw
• Develop need to touch everything or put things in mouth
• Sleep longer and more often
• Become bedridden
• May become very thin
• Difficulty eating and swallowing
• Unable to care for self
• Loss of bowel and bladder control

Damage to the brain from Alzheimer's disease or other types of dementia can cause a person to behave and think in different or unpredictable ways. These behavioural and psychological problems often change as the disease progresses. Challenging behaviour and thoughts can cause discomfort to individuals with dementia and can make caring for them both frustrating and difficult.

Unfortunately, behavioural and psychological symptoms of dementia can often lead to early institutionalization of these patients who could otherwise still be cared for at home. Learning to effectively manage these unusual behaviours and thoughts is therefore very important for caregivers. This booklet provides information on strategies and available treatments that may help you deal with these issues.

Common Behavioural and Psychological Symptoms in Dementia

Behaviour or Psychological Symptom Signs to Watch for Wandering Walks away from home unattended with the risk of becoming lost Restlessness and Agitation Paces nervously, drums fingers or other restless activities for long periods of time Repeated Actions Repeats words or actions over and over again Suspicion Thinks others are trying to hurt them or steal their possessions Sexual Behaviour Removes clothing, exposes self, makes physical and verbal advances towards others Aggression Physical and emotional outbursts (hitting, shouting, swearing) Anxiety Worried, scared, tearful Depression Sad or low mood, not interested in life, tearful Hallucinations* Sensing something that isn't really there (seeing, hearing, tasting, smelling or feeling things that aren't real) Delusions* False beliefs (that someone is trying to hurt them, someone is watching them, someone is stealing their thoughts) *Hallucinations and delusions are symptoms of psychosis. The term psychosis means that a person has lost touch with reality and finds it difficult or impossible to distinguish between what is real and what is not.

(Treatment)

How to Manage Behavioural and Psychological Symptoms of Dementia

When a problematic behaviour arises, it is a good idea to have the patient with dementia seen by a physician. Behavioural symptoms can often be a result of treatable medical conditions. These can include:

• Physical discomforts
• Medication side effects
• Pain
• Infection
• Nutritional deficiencies
• Dehydration
• Impaired vision
• Impaired hearing

If behavioural and psychological symptoms of dementia are not a result of a treatable medical condition, they may be controlled by a number of other strategies. This may or may not include the use of medications.

Non-Medical Treatment of Behavioural and Psychological Symptoms of Dementia

Non-drug treatments of behavioural symptoms of dementia are often recommended as a first option. By following these simple steps you may be able to modify the challenging behaviours of the dementia patient.

STEP 1

Identify the behaviour that is challenging and that you wish to modify. A clear definition of the problem can help make the solution to the problem more obvious. It is best to only tackle one behaviour at a time.

STEP 2

Gather information about the behaviour. How often does it occur? When does it happen? Where does it happen most? In whose presence does the behaviour occur? Daily diaries can help you keep track of these questions and answers.

STEP 3

Identify what happens before and after the behaviour. Are there triggers that lead to the behaviour? Does there appear to be a cause of the behaviour? There may be several triggering factors that lead to the difficult behaviour. Are there consequences of the behaviour?

STEP 4

Set realistic goals and make plans to modify the behaviour. Involve the person with dementia whenever possible. Start with small goals and when those are achieved move onto the next goal. Don't expect big changes overnight. It will take time and effort to modify a behaviour.

Strategies to Deal with Challenging Behaviours and Psychological Symptoms of Dementia

After following the above steps you can attempt to change or cope with the challenging behaviours of a person with dementia. These suggested strategies may help.

• Look for an immediate cause. If possible, eliminate the trigger for the behaviour from the environment. This may involve removing mirrors or pictures that can be confusing for people with dementia. Often loud noises can be triggers for challenging behaviours. Regular physical activity can help prevent certain behaviours such as wandering. Needs that the person cannot express may lead to problem behaviours. Do they need to use the toilet? Are they too hot or cold? Are they lonely or bored?
• Distract the individual with other meaningful activities. Replacing the challenging behaviour with other activities is often successful in preventing problem behaviours. Planned activities help individuals feel independent and needed by focusing their attention on pleasurable or useful tasks.
• Determine how important the behaviour is to you and the individual with dementia. Even if a behaviour is not normal, it may not be bothering you or the dementia patient. If that is the case, it may be best to allow the behaviour to continue.
• Calm the person with dementia and provide comfort. Many behaviours can occur when patients with dementia become worried, agitated or restless. Calming music or a soothing touch can go a long way in preventing these behaviours from occurring. Keeping familiar personal possessions visible to ensure comfort and feelings of familiarity may help as well.
• Look for a pattern of the behaviour. If the behaviour is occurring at the same time each day, it may be helpful to arrange your schedule so that you can spend time with the person to try and prevent the disturbing behaviour.
• Do not argue or try to reason with the dementia patient. Many patients with dementia have lost the ability to reason and won't understand your argument.
• Do not judge or scold. It is impossible for you to completely understand what the dementia patient is going through. You may not understand their behaviour, but you can help by providing affection, reassurance and support.
• Provide the patient with some privacy and quiet time. We all need time to ourselves. This can help prevent inappropriate sexual behaviour and aggression.

Even with non-drug treatments, medication is often necessary to effectively treat the behavioural symptoms of dementia. A number of different medications have been tried and studied, but only one medication is actually approved by the government for the treatment of inappropriate behaviours in.

Caring for a patient with dementia is no easy task. Don't be afraid to seek the help that you need. The following is a list of contacts for help, support and more information on dementia.

Internet Resources: