Glossary of Essential Dementia Behaviors and Symptoms: Part I

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

All righty. Hi everybody. Welcome to another brand new episode of The Truth, Lies Alzheimer's Show. And I'm your host, Lisa Skinner. One of the things that I have maintained for probably close to 30 years now, is the key to effectively and successfully getting through this journey with a loved one or somebody you're caring for living with Alzheimer's disease and related dementia is understanding this disease. As I've said before, so many people just think it is exclusively a disease that destroys memory and creates confusion. But if you've been listening to me long enough, you will know now how complex these diseases really are. So today, what I'd like to do is I am going to go through a glossary of common behaviors that we see with dementia. Some of these you may have heard of, some of them may be new, but the point being is I want you to be aware of every single one of these common behaviors and symptoms so you will recognize it if it shows up in your dementia world and you'll know to expect it and recognize it so you understand that it's all part of living with dementia. I'm going to do this in two parts. This will be episode one because there's a lot of them. There are a lot, a lot, a lot of symptoms that fall into the bucket of dementia. And I'm going to go through each one of them and give you a little, um, explanation of what each one means so you'll know what to look for and what to expect. All right, so the first one is aggression. Signs may include a hostile or destructive mental attitude or behavior, such as a harmful action towards another person. Aggressive behaviors can be physical, such as hitting or pushing, or verbal, such as shouting, screaming, or name-calling. Then we have agitation. Signs may include restlessness, fear, pacing, and different than normal body language and facial expressions. Some people become angry. Signs may include displeasure, resentment, indignation, and/or rage. Anxiety. Signs may include irritability, depression, pacing, constant movement, restlessness, and general emotional distress.

Apathy.

Signs may include an absence of emotion or an absence of interest or enthusiasm for things generally considered interesting. Aphasia. Signs may include the loss of ability to communicate, such as difficulty understanding and/or expressing spoken or written language. Aphasia may be mild, but it can be severe. With mild aphasia, a person may be able to converse, yet have trouble finding the right word or understanding complex conversations. Severe aphasia limits a person's ability to communicate. A person may say little and may not participate in or understand any conversation. Now it gets a little bit more complicated than just aphasia because there actually are many different types of aphasia that I want you to be aware of. So the first one is called anomia aphasia, where a person may speak normally but has difficulty in articulating the name of an object or place. There's conduction aphasia, which means a person has trouble repeating words spoken by someone else, otherwise their speech is fairly normal. There's expressive aphasia, or Broca's aphasia, as it's also known as, where a person can hear and understand but cannot express his or her own thoughts. Fluent aphasia, where a person speaks normally or rapidly but may unconsciously substitute words or sounds with incorrect choices. They don't realize that they are making these errors, so they will not correct themselves. For example, they may say cat when they really mean dog. There's global aphasia where a person has difficulty in speaking, repeating, or comprehending language altogether. Then we have non-fluent aphasia. A person speaks slowly and with difficulty. They may grimace or use hand gestures in attempting to communicate. They may leave out words and endings of words when speaking. And then finally, we have what's called receptive aphasia or Wernicke's aphasia. Now, this is where a person can hear what is said but cannot understand. They can speak but cannot understand or monitor their own speech. Now, people with aphasia can be displaying one of these types, subtypes, or many of them. So the best thing is be aware that they exist, and hopefully if, you know, they are having difficulty in one of these types of communications, you will recognize it as one of the types of aphasia. Next, we have a catastrophic reaction. Signs may include hitting, yelling, running, and/or combativeness. It is an extreme emotional reaction that is actually considered out of proportion to the actual event. They're really blowing this thing up. A catastrophic reaction occurs when a person is unable to communicate or articulate a need such as having to go to the bathroom, experiencing pain, or is the result of a frustrating situation that continues to escalate because the person with dementia does not feel that they're being understood or heard or listened to. Now, this behavior may occur suddenly without any apparent reason. Of course, we all know that a lot of people with dementia experience severe communication difficulties, and those signs can include the inability to properly communicate one's needs due to the effect dementia has on the brain, resulting in problem behaviors. They may also include problems with word finding, Putting one's thoughts smoothly into words and the ability to understand written or verbal language. Most often the behaviors are triggered by frustration, anger, agitation because a person doesn't understand what he or she is being asked to do and are unable to make themselves understood. Of course, we all know confusion is a very common symptom and behavior of Alzheimer's disease and related dementia, and those signs could look like somebody losing track of dates, seasons, the passage of time, such as forgetting where they are or how they got there, or having trouble understanding something If it is not happening immediately, if you tell somebody you're taking, hey mom, I'm taking you to the doctor at 1 o'clock and it's 9 o'clock in the morning, they're gonna think that that's the next thing that's going to happen. They don't differentiate between 1 in the afternoon and 9:01 in the morning. So it's best not to assign times to things that are planned for the day because they're going to think that it's going to happen. The very next thing that you're all going to do is what you told them. They, they're not going to recognize the time. Delusions. Signs may include believing in a false idea that is contrary to fact and remaining persistent to that belief. Such as insisting that you are not my son. Depressive behaviors are quite common. Signs may include impaired concentration, memory loss, apathy, lack of interest in formerly enjoyed activities. You can see overwhelming sadness, crying more than usual, significant weight loss or weight gain, sleep disturbances, or sleeping more or less than usual, restlessness, feelings of guilt or worthlessness, and/or talking less than usual. These are all signs of depression, which is very common with dementia. We see disorientation. What that looks like. The signs may include the inability to know one's place or time, and I'll give you an example: not knowing the day of the week or the time of day, or getting lost in familiar places and/or not recognizing familiar places or things such as somebody— their bedroom. We see this a lot. Disorganized behavior signs may include, include bizarre or socially inappropriate behavior such as undressing in public, screaming in public, collecting unusual things such as napkins. My mother-in-law was a napkin collector and she would spend endless hours folding a napkin into a square, putting it in her purse, and then a few minutes later opening her purse, taking the napkin out, and starting all over again. There's a chapter in my book called Fold, Tuck, Repeat, and it is an illustration of this very thing, and she was famous for that. Disrobing. This is not that uncommon. People with dementia, for obvious reasons, signs may include taking their clothes off at inappropriate times or places and may be a sign of discomfort or even boredom. Eloping. This does not mean they're running off to get married. Signs may include watching the exit doors, elevators, etc., in the hopes of finding an opportunity to escape from their current surroundings. And then we have the infamous hallucinations. Signs may include false perceptions of objects or events that a person with dementia may to see, hear, smell, taste, or feel something that isn't actually there, such as hearing someone talking who isn't there or seeing insects crawling on walls that are not there. With my grandma, she saw rats running along the walls and was convinced that they were invading her home. Hoarding is common, and those signs may include stockpiling, storing, or collecting items and placing them in a hidden or carefully guarded place for preservation or future use, etc. One of the things that I learned a long time ago especially in the Depression-era generation where so many of the folks that are living with Alzheimer's disease and dementia developed. And because of their experiences growing up with very few, very little food, very little clothing, a lot of those folks became hoarders because they'd see something and because they lacked so many things as they were growing up, they want to hold on to these things as trophies. They're, they're just precious to them because they, they were so scarce when they were growing up, which makes total sense to me. There's impaired concentration. Now, these signs may include difficulty in paying attention and in staying on task. Impaired judgment— those signs may include the inability to use reasoning skills in using judgment or decision-making, such as when it's safe to cross the street or when dealing with money. Impaired visual images and spatial relationships— This might look like the inability to interpret what one sees, to properly recognize objects or sounds or shapes or people, even when their eyesight is not impaired. A person may have difficulty in reading, judging distance, and determining color or contrast. It's not unusual if you serve a meal to somebody on a white plate, that's the plate sits on a white tablecloth. They might not be able to differentiate between the plate of food and the table with the white tablecloth because the colors are the same. So it's best to contrast those colors. Put a red plate on a white tablecloth. This is actually very common, and, um, it's really important to be aware that this happens so you'll know to do a contrasting color. The inability to sequence tasks. Now, those signs may include the inability to perform a skilled or learned task that requires putting together steps of a process. Such as getting dressed or even taking a shower. Let me give you a good example. I mean, we've all learned from early age how to brush our teeth, and it becomes second nature by the time we're adults. You don't even think twice about the sequence of tasks that you perform to brush your teeth. That all goes away with dementia. You might be staring at your toothbrush in its holder with dementia and you don't have a clue that you're supposed to pick it up and in your fingers, lift it out of the toothbrush holder, run it under water, put the toothpaste on it, and, you know, follow the sequence of steps of brushing your teeth. People lose that ability to sequence tasks. Inappropriate sexual behavior. Signs may be masturbating in public, disrobing, attempting to have sex with an inappropriate person or thing, and a person may mistake another person for their spouse. And I've seen this happen time and time again, like in memory care wings. Where they think they're doing nothing wrong because the person that they're trying to be intimate with, they actually believe is their spouse. And so recognize that this is a common occurrence, more, probably more so with men than with women. Incontinence is very common, and of course we know that those signs may include lack of control or involuntary urination and/or defecation. Memory loss, of course, difficulty recalling the most recent events. Misplacing things. Signs may include putting things in unusual places, misplacing objects, and not being able to retrace their steps. Many times this results in accusing others of stealing because they can't remember where they put whatever it is they can't find. We see mood changes about, you know, they become easily confused, suspicious of others, suspicious of situations, depressed, fearful. Anxious, and very easily upset for no apparent reason. It's very common for people living with dementia to do what we call layering their clothing, and those signs include putting on multiple layers of clothing, such as 3 different sweaters or several different pairs of pants, etc., at the same time. This is very common, and it is part of living with dementia. Pacing is common. Signs may include excessive walking up and down a hallway or in and out of a building or around and around a building with no specific purpose. Paranoia, unrealistic blaming belief such as unreasonable suspiciousness that someone has stolen something or that someone is doing something that they are not. We see extreme, mild to extreme personality changes. The signs may be noticeable differences in personality from when a person was healthy or exaggerated changes in normal personality characteristics. I have seen so many variations of that. Very sweet people when their brains were healthy, and they turn mean and nasty and swear like a sailor. And then the opposite happens too, and anything in between. Now, this was one that you might not be aware of. It's called pocketing. And that may include a person holding small bits of food between their cheek and their gums. I've seen this a lot. Be careful of choking. All of a sudden developing really poor table manners. Those signs may include mixing, stirring, pouring, not using their utensils, using inappropriate condiments, etc., due to not recognizing or remembering the proper ones to use. And we see psychosis, which includes hallucinations, delusions, and/or paranoia. I am going to, uh, continue with the rest of these in episode 2. So hopefully I don't want to overwhelm you with information overload. I want you to, to know these so you'll be able to recognize them. And at some point we will address how to successfully and effectively respond to these behaviors that we see in people living with dementia. So that'll conclude this episode for today. I really appreciate everybody being here. And you may need to listen to these a few times to have them, you know, really register and understand that these are all part of the disease. And I'm Lisa Skinner, your host of the Truth, Lies Alzheimer's show. And then next week we will be providing the second part of this episode for you to learn the rest of some of these challenging behaviors that we see living with Alzheimer's disease and dementia. So until then, have a great rest of your week, and I appreciate all of you listening to my show, and hopefully this is making your world a lot easier to deal with in whatever your journey happens to be with Alzheimer's disease and related dementia. So bye for now.

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