Many of the psychiatric symptoms and, later in the disease, the behavioural disturbances of Alzheimer’s disease, can be managed and treated very effectively without the need for drugs. The first thing that a doctor or nurse should do is to make sure that the patient and carer understand that the symptoms, generally speaking, arise as a consequence of the disease
For example, if a person suffering from Alzheimer’s disease misplaces a wallet or handbag, he or she may accuse someone else of moving it, or even having stolen it. A brief explanation that this can be seen as a natural response to forgetting where something is, can be helpful. A strategy, such as always putting a wallet or handbag or set of keys in one place, may be a solution.
If a sufferer has an idea which is firmly held, there is little point in trying to convince them that they are wrong and you are right. For example, some people with Alzheimer’s disease say that their parents are still alive. when they are dead. Sometimes people will try to get the person with Alzheimer’s disease to say what age they are and then to calculate what age their parents would be if they were alive to prove they are wrong. This is an unhelpful approach and could be seen as serving only to humiliate the person. On the other hand, it is important not to agree with somebody, especially if their idea is clearly abnormal. The secret is probably never to completely agree or disagree but somehow take the middle ground.
It is also very common for people with Alzheimer’s disease to repeat the same question again and again. It is best to try to avoid becoming irritable with the person and saying, ‘You’ve asked me that question a hundred times’. They simply cannot remember. A technique which may be helpful in this situation is validation therapy. The principle behind this is to accept that recurrent themes emerge in repetitive questions or repetitive speech and that these themes reflect unmet needs or anxieties on the part of the person with Alzheimer’s disease.
Often old memories of significant life experiences’ can emerge and dominate that person’s reality for a period of time. Validation therapy allows us a way of entering into and sharing that person’s reality to offer support and reassurance. The person who asks repeatedly, ‘Where is mother?’ may be reliving significant memories of their mother. Rather than reminding them that their mother has been dead for some years, which is a harsh approach, we can talk with them about their mother but always using the past tense. An opening comment such as, ‘You’re clearly thinking about your mother; she must have been a very important person in your life, so tell me about what she was like, allows the person with Alzheimer’s disease to express their concerns and anxieties. It allows them to talk about their mother and to remind themselves gradually that their mother indeed passed away some time ago.
Some behaviours such as aggression or screaming, when people are in the later stages of Alzheimer’s disease, can be treated with what are called ‘behavioural techniques’. In a sense it is a little like training children in that it is important to reinforce and give rewards when someone is good and not exhibiting bad behaviour rather than simply constantly telling them off when they are bad.
When someone becomes agitated or excited it important to try to step back from the situation and to identify anything that seems to cause a particular behaviour, anything that seems to keep it happening and anything that seems to stop the behaviour. It may be that patterns will emerge which would be helpful in understanding and managing a particular symptom. For example, it is not uncommon for people with Alzheimer’s disease to become agitated and excited in the evening. An example of this would be a woman suffering from Alzheimer’s disease who begins to get agitated and worried when her husband, whom she is expecting home for his dinner, has not arrived.
Adopt a person-centred approach
Understanding the behaviour of the person with Alzheimer’s disease rests almost exclusively upon trying to understand more about the person who is experiencing it Adopting a person-centred approach reminds us that it is the unique individual who is important rather than the label or diagnosis they have acquired. Everyone with Alzheimer’s disease has a unique life history, set of relationships, personality, habits and preferences. Understanding these can often help to determine the context of challenging behaviours and the messages that lie behind such behaviours.
The most important thing to remember when dealing with psychiatric symptoms or behavioural disturbances, and trying to manage them without: drugs, is to understand that the person’s actions, are not under their own control and it is important to avoid getting angry and frustrated – however impossible this may seem! Also, and often contrary to popular belief, people with memory loss are able to respond to a kind, gentle and consistent approach and it is very important to try a strategy like this before resorting to drugs.
There are a number of other treatments which can help control agitation in people with severe Alzheimer’s disease. A technique called ‘the snoozelen’ is a room where there are sounds, music, and things to touch and feel. This approach can decrease agitation in people with Alzheimer’s disease. Likewise, there is some evidence that light therapy (where the person sits in front of a light box) can make people feel more calm.
In summary, try a non-drug approach to manage behavioural problems first, looking for explanations for the reasons behind behaviours, and avoid challenging the person with Alzheimer’s disease even if they are obviously wrong. Do remember that the reactions of the person are often not under their own control.