Around 20% of people with Alzheimer's experience "sundowning," which is increased confusion, anxiety, agitation, and disorientation that starts with dusk. Closing the curtains and turning on the lights before dusk can help (Alzheimer's Association, 2007).
Watch a video that describes typical emotional problems in dementia (2 minutes long).
People with dementia who are aware of their loss of abilities to communicate, remember, and function as before may feel a range of emotions, including:
Furthermore, some people with dementia may become upset or suspicious because they misunderstand things they overhear. Also, the disease process itself may lower a person’s inhibitions to expressing emotions. For instance, a person with dementia may do things she did not do before having dementia, such as having angry outbursts or spells of extreme laughter.
Anger often arises as a response to feeling frightened, frustrated, or humiliated. What might seem like random aggression could be the result of something in the environment. For instance, some caregivers report that their loved ones tend to act out when they are out in public. Visiting new places and being surrounded by strangers can be frightening for individuals with dementia. Likewise, being surrounded by lots of activity and noise can be distracting or upsetting. Some people with dementia may also get angry or frustrated when a caregiver tries to assist them or when they can’t successfully perform a task.
Strategies: Caregivers should try breaking down complex tasks into manageable steps. Focus on achieving each step before giving your loved one further instructions that might be hard to remember. Many caregivers find it helpful to give their loved ones a task that allows them to have a say in what is happening, even if it is to tell you whether or not something is okay. Finally, if all else fails, give your loved a chance to calm down in her own time. Remember not to take it personally – the behavior is caused by the disease.
Depression is a common experience for individuals with dementia. The feeling of social isolation and loss of control that comes with the progression of dementia may contribute to depression. It can sometimes be difficult for caregivers to distinguish depression from dementia since some of the symptoms are the same, such as apathy, memory loss, or trouble sleeping.
There are some important differences between depression in people with dementia and depression in people without dementia. Depression with dementia is likely to involve change in mood, delusions, agitation, and anxiety while other symptoms usually associated with depression, such as guilt, suicidal thoughts, and low self esteem are not as common. Therefore, it is important that the physician who evaluates the person with dementia be familiar with what depression looks like when paired with dementia. Caregiver input is also important in diagnosing this form of depression.
Strategies: Caregivers who are are concerned about their loved ones depression should talk to the doctor so they can find out if medical treatment or counseling are warranted. Caregivers may also try to make more of an effort to keep their loved ones active and to keep them socially involved.
New places and faces can be unsettling for individuals with dementia, especially as the memories of familiar places and faces fade away. Some people respond to anxiety by pacing, insomnia, and restlessness while others may choose to cling to familiar objects or individuals.
Strategies: The best thing that caregivers can do for a person with dementia who is feeling anxious is to reassure her and remind her how much they care. Additionally, many caregivers find it helpful to come up with activities that their loved ones can focus on instead of worrying. For instance, if a person with dementia becomes anxious whenever her caregivers have to leave the house, the caregivers might try leaving notes telling her where they are and when they will be returning.
There is no simple way to make things better, but there are actions you can take to help your loved one deal with emotions when they arise. Remember, you may not always be able to control your loved one’s emotions, but you can control your own reactions to them. Try following these 3 steps (the 3 R’s) for dealing with emotional outbursts:
Start out by letting him/her know that you are there. A simple touch can calm an upset person. However, touch may also further trigger emotions for someone who is already aggravated.
"I’m here, I will help you."
Regardless of whether s/he is reacting to something that you consider serious or trivial, it is important to recognize and respect his/her feelings.
"It sounds like you are upset that you will be late."
Rather than allowing your loved one to dwell on a subject that is difficult or painful, try to redirect the conversation. The best way to redirect a conversation is to listen and to follow the flow of the conversation.
"Being on time must be very important to you. You always were very considerate of other people like that. Was it important for you to be considerate of others growing up?"
Alzheimer’s Association. Sleeplessness and sundowning. In Living with Alzheimer’s. 2007. Available at: http://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp. Retrieved March 27, 2009.
Source: Alzheimer's Association
Description: This web page, also available in Spanish, discusses the range of emotions expressed by individuals with dementia and how to react to and prevent emotional episodes.
Source: Alzheimer's Association
Description: This printable brochure provides an in-depth discussion for how to respond to specific emotions such as aggression, anxiety, confusion, repetition, and suspicion.
Source: Alzheimer's Society (United Kingdom)
Description: This web page specifically addresses aggressive behavior and takes you through five steps for dealing with emotions, from personal reactions and feelings, to recognizing and working with a loved one's "triggers."
Source: Alzheimer's Research Foundation
Description: This article discusses aggression and outbursts in patients with Alzheimer's. It offers insight into why these reactions sometimes occur, and ideas on how to help prevent and handle them.
Source: Alzheimer's Association, New York City chapter
Description: This article describes the combativeness that you may experience from your loved one. It offers insight into why this behavior may happen, and offers advice on how to deal with it.
Source: Alzheimer's Association
Description: This fact sheet discusses depression and how it affects individuals with dementia. It also provides information on drug and non-drug treatments.
Source: Alzheimer's Association, New York City Chapter
Description: This article describes causes of agitation among people with dementia, and offers advice on how to treat agitation, and provides helpful hints on preventing agitation and dealing with an episode.