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Dementia:  Why Are They Acting Like That?

Symptoms of dementia are often subtle during the early stages of a disease process and progress gradually.  Surprisingly, people who are experiencing dementia can be quite skilled at covering up their deficiencies for a period of time. Sometimes changes which are noticed by others may be attributed to “just growing older.”  Regardless of when symptoms are noticed, living or interacting with someone with dementia can be challenging.

Various techniques are available which can improve interaction and communication with individuals who are experiencing symptoms of dementia  A basic understanding of what is happening in the brain of an individual with dementia can help others use these strategies more effectively through a better appreciation of why certain behaviors occur.

The brain is a highly complex organ, and although certain areas of the brain are associated with specific functions, often several parts of the brain are working together to process information and develop a response.  Memory loss is often the primary symptom associated with dementia.  This may be because the area of the brain which is responsible for learning new information and forming new memories is often affected first.  Dementia, however, is much more than memory loss.

For example, an individual experiencing dementia may have difficulty eating a meal.  This difficulty could stem from changes in vision which prevent the individual from recognizing a familiar food or an eating utensil.  If only the field of vision is affected, the person may see and recognize someone else’s plate of food but not the plate in front of him/her.  The individual may be able to see and name an eating utensil as a fork, but another area of the brain is needed to understand the function of the fork. A third area regulates space and perception, impacting the ability to get food onto the fork or figure out where the fork is in relation to the mouth.  Different sections of a yet another part of the brain control the muscle movement necessary to pick up the fork or move the fork to the mouth; as well as memory of the sequential steps involved in eating such as picking up the fork, holding it correctly, putting food onto it, and getting the food into the mouth.  Suddenly eating, a task which everyone does multiple times a day without really thinking about it seems like a very complicated task.

Symptoms of dementia are the result of damage to one or more areas of the brain which regulate these various tasks, or the inability of brain cells in different areas of the brain to communicate with each other for completion of the task.  Identification of the part(s) of the process which is breaking down is essential to determining what type of strategy to utilize to try to overcome the difficulty.

Emotions are also key to understanding the behavior of someone with dementia.  Take the eating example from above.  Perhaps an individual doesn’t have any of the challenges mentioned and usually eats everything on the plate independently.  Yet one evening, the individual refuses to eat.  Thoughts of a recent snack or potential illness may be the first suspected causes of this change which cross one’s mind.   In actuality, the individual may smell some type of food which is associated with an unpleasant event.  The person may not be able to identify the odor, tell you that he/she doesn’t like the odor, or recall the unpleasant event associated with the odor.  But the odor evokes strong emotion which the individual acts upon by refusing to eat.

Emotion also plays a less obvious role in relation to other behaviors.  The brain’s inability to accurately process information and resulting lack of understanding about the surrounding environment can create an underlying level of stress for an individual.  This stress is reflected in behaviors such as holding someone’s hand very tightly (deep pressure feels good, especially the palms and fingertips), usually answering “No” to yes/no questions (it feels safer to maintain the status quo), and a change in eating habits (stress increases the body’s desire for sugar, salt, and fats).  This stress can also result in the perception of situations to be more threatening than they really are; such as when someone reaches out to touch them or approaches from behind and startles them.  The fight or flight response may be triggered in these situations and the reaction may be physically aggressive, even from a normally easy-going individual.

The complexity of the brain can make the symptoms of dementia seem incongruous, such as when an individual can solve a page of math problems but is unable to tie a shoe.  Strategies to promote effective interactions with individuals who are experiencing dementia require patience, creativity, and flexibility.  A strategy which works one time may not work when a similar situation occurs again.  Caregiving for individuals with dementia presents unique challenges, and a team approach can help reduce caregiver exhaustion.

Karen Kaslow, RN, BSN