Behavioral Management of Secondary Symptoms of Dementia

August 24, 2007

As Alzheimer disease progresses, the affected individual frequently behaves in unusual ways, and these new behaviors may embarrass family members when carried out in public. Unfortunately, some caregivers feel so sell-conscious that they further restrict their social activities. It may prove helpful if the caregiver can find humor in such situations, rather than suffer embarrassment.A spouse related an incident concerning her Alzheimer husband that stirs fond memories. She and her husband were having a hamburger at a take-out restaurant when she noticed that her husband’s pants were unzipped. When she pointed this out to him, he was completely undisturbed and saw no reason to correct this unimportant problem. As he explained to his wife, “Oh well, it’s not going anywhere. “

Some Alzheimer behaviors may develop that create problems for the patient or the caregiver. The unzipped pants were not perceived as a problem by the patient but they posed an awkward situation for his wife. According to Paul K. Chafetz, a clinical psychologist, many behaviors that create problems for the Alzheimer patient and the caregiver can be humanely altered by applying principles of behavior modification. His essay provides an overview of such behavioral management principles and some practical information that may serve as a useful guide to the caregiver in attempting to modify unwanted patient behaviors.

The primary and defining symptoms of dementia refer almost exclusively to declines in such cognitive abilities as intellect. memory, language, and executive function. Secondary symptoms of dementia, however, are those behaviors that disturb other people, place excessive demands on care­givers, disrupt the patient’s environment, or threaten the patient’s own well-being.

The distinction between primary and secondary symptoms of dementia is extremely important. This is because primary symptoms usually cannot be much improved with today’s health care tools. while secondary symptoms, if properly recognized, can often be significantly improved with existing methods. In Alzheimer’s disease, the progressive loss of mental abilities is directly linked to progressive damage of brain tissue caused by physical illness. Since many details of this disease process are still inadequately understood, little or nothing can currently be done to stop or reverse it.

Secondary symptoms, in contrast, are, in large measure, responses to the particular environment in which the patient functions. Environment refers to all sources of stimulation available to the patient, including people, animals, objects, colors, temperatures, smells. and so on. Even such factors as personality, personal history, and current life situation are believed to have a significant controlling influence on the behavior of demented individuals. Unlike the reality of unchangeable brain tissue disease, environmental conditions that have allowed undesirable behaviors to develop can be changed. It would be tragic and foolhardy not to pursue aggressively the therapeutic options that behaviorism presents.

Posted in Alzhemier Disease