Alzheimer's - What Behavioral Changes to Expect?
Alzheimer’s is one of the most famous diseases that are characterized by memory decline. Memory pervades so much of our daily life, and to have this component of our mind slowly taken away creates jarring consequences. The first step in caring for someone with Alzheimer’s disease involves becoming familiar with what changes to expect. We wrote about physical changes in a previous article, and I’m devoting this post to behavioral modifications. Again, we're breaking Alzheimer’s into discrete stages, but please be advised that the disease sees no boundaries and progresses gradually, so some observations may seem out of place in relation to your particular experience with the disease.
Early Stage Behavioral Changes
In the earliest stages of Alzheimer’s progression, the changes that you notice in your loved one can be small and subtle. They may have trouble remembering the day of the week or month. Sometimes, they can ask you the same question or tell you the same story two or three times. It’s not uncommon to see certain parts of household management begin to falter: bills may be unpaid or incorrectly paid, food may be left in the refrigerator or pots may be left on the stove.
In addition, driving may be compromised as spatial orientation begins to become more difficult. Finally, you may see mood changes in your loved one. He or she may express denial about the diagnosis, and may withdraw from activities or experience a degree of apathy towards tasks they once enjoyed.
Middle Stage Behavioral Changes
As the disease progresses further, many of the behaviors above will increase in severity. For example, your loved one may routinely forget the day of the week and need to be reminded every few hours. Reading, writing and arithmetic may become too arduous of tasks to complete, and so chores such as balancing the checkbook are no longer possible.
In addition, behaviors such as anxiety and suspicion may begin to emerge and these are often very difficult to deal with. Your loved one may misplace his or her wallet, and then accuse you of stealing it from them. They may become violent – shouting and hitting are often common. Table manners may decline, and inappropriate sexual behavior may rise.
Behaviors may also change with the time of day. For example, sundowning refers to an increase in agitation that occurs in the late evening. Your loved one will begin to need help with personal care. They may have trouble with bathing, dental care, and general grooming, and will need your assistance in order to maintain a good level of hygiene.
Late Stage Behavioral Changes
In the final stages of Alzheimer’s progression, most of the agitation will dissipate, as your loved one will most likely be spending a significant amount of time sleeping. During periods of wakefulness, however, he or she will probably need help with most everything that they do, whether it’s dressing, eating, bathing, or walking.
At this stage, it is common for your loved one to recognize very little in their environment. They most likely will be unaware of where they are or who is taking care of them. Frequently, they will lose the ability to communicate, which will require you to be even more vigilant of problems or complications that may arise.