Further Your Understanding: Dementia and Mood

Some people say Dementia turned their once loving and upbeat loved one into an angry tyrant. Others may describe the changes in behavior and mood as “the same person, only more so.” Usually, “more so” is not good. Rarely does one hear that Dementia turned a difficult person into a pleasant one.

The behaviors associated with early-stage Dementia can be the most difficult. Your loved one is fighting the imposed changes the diagnosis has brought to his or her life. And you, the family caregiver, do not have the experience to both calm your loved one and cope with the disquiet this new relationship brings into your life.

As Dementia progresses from early to late-stage, moods, and behaviors worsen. In addition to increasing memory loss, depression, belligerence, apathy, physical aggression, wandering, repetitive questioning enters the picture.

It is useless to try to convince your loved one that what they truly believe is not what it seems. You will never win the argument.

How to Deal with Changes in Mood with Dementia

“Distraction and redirection” is one helpful strategy to diffuse the situation. Rather than trying to prove his or her hat was misplaced and not stolen, make a comment about the nice weather and suggest going for a walk. Another way to address your loved one’s concern is to listen and tell him or her you will look into the matter. This simple tactic tells your loved one you are there; you care, and you will make things right.

“Therapeutic deception” is another approach to managing difficult behaviors. Telling your loved one, “you will make things right,” isn’t a lie. It’s a kindness that gives him or her, and you as well, a few moments of peace. You will find a therapeutic deception is an approach you can apply to various difficult circumstances.

Dementia behaviors may also include some weird and scary things. More specifically, your loved one may experience hallucinations. How you respond to these unsettling behaviors has the potential of turning uncomfortable moments into situations that may necessitate assistance from your local police department or a trip to the emergency room.

Managing the difficult behaviors associated with hallucinations involve a different set of challenges. Telling your loved one, there isn’t any blood on the walls or bugs crawling up his or her back is fruitless. Hallucinations are sensory tricks. Your loved one sees, hears, or feels something without the stimulus of light, sound, or touch. To prevent a difficult situation from escalating into one you cannot manage, you might say something like, “I cannot see what you see, but I am sure it is very scary.”

You might remind your loved ones that you are there and that you will make sure they are safe. Sometimes a hug or a gentle touch will have a calming effect. Other times, when hallucinations cause overwhelming fear, the only thing you can do is take your parent to the emergency room.

Medication to reduce mood and behavioral difficulties is a controversial issue. Some people believe the drugs used to manage behavior are “chemical straight-jackets” meant only to make things easier for the caregiver. Other caregivers subscribe to the philosophy that providing meaningful activities for the person with Dementia, establishing a structured routine, and creating an enriching and pleasant environment can reduce the need for behavior modifying medications. In either case, one has to consider the quality of life. Medication can reduce pain and suffering. If depression becomes overwhelming, belligerence creates a dangerous environment for the caregiver, or when hallucinations cause unrelenting terror, medication is both humane and one that supports a better quality of life.

All of this is easier said than done, but do try to remember it is the disease that is speaking and not the person you once knew.

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

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