How to deal with agitation in the dementia sufferer

By Micha Shalev

Dementia is not an inevitable consequence of aging, but the risk of dementia increases sharply with advancing age.  Its prevalence is expected to increase dramatically over the coming decades.

Dementia features an alteration of memory and at least one other cognitive disorder such as language difficulty, inability to perform particular purposive actions, or a disturbance in the ability to organize thoughts and activities. Various conditions are related to dementia, such as strokes, head trauma, Parkinson’s disease and substance abuse.

Yet Alzheimer’s disease is considered the most widespread form of all senile dementias, representing more than half of all cases. The onset of dementia of the Alzheimer’s type is gradual and involves continuing cognitive decline.

In addition to cognitive symptoms, individuals with dementia often present behavioral and psychological symptoms, which may increase their suffering, be difficult to manage by caregivers and precipitate institutionalization. Behavioral symptoms of dementia include wandering, screaming and hitting, while psychological symptoms include hallucinations, delusions and depression. Between 50 and 90 percent of dementia patients have behavioral or psychological symptoms.

The term “agitation” is often used in reference to behavioral symptoms associated with dementia. Agitation was originally defined as any inappropriate verbal, vocal or motor activity, which, according to an outside observer, does not result directly from the needs or the confusion of the agitated person.

Behavior, which constitutes agitation, can be broadly classified as aggressive vs. non-aggressive and physical vs. verbal. A factor analysis of a measure of agitation used with nursing home residents produced three factors which make it possible to distinguish various forms of agitation: aggressive behavior (such as hitting), non-aggressive physical behavior (such as pacing) and verbally agitated behavior (such as complaining).

The specific determinants of agitation remain unclear. Predisposing factors may include gender, personality, poor health and functional impairment of activities of daily living, as well as cognitive and neurological deterioration.

Other factors may precipitate the occurrence of agitation and include the characteristics of the physical and social environment, such as too much noise or not enough social interaction, as well as physical needs such as hunger, thirst and discomfort. Some of these variables, such as sex, the severity of cognitive impairment and the level of dependence in performing activities of daily living, are well documented in terms of their relationship with different types of agitation. For example, males are more likely to be aggressive than females.

One of the challenges in learning to communicate with a person who has dementia is that people with dementia often find it hard to remember the meaning of words or to think of the words they want to say. During the late phases of the illness, people with dementia may communicate mainly by gestures and expressions. The following suggestions may help you communicate with a person who has dementia:

•If you are about to lose your temper, try counting to 10, remembering that the person has a disease and is not deliberately trying to make things difficult for you.

•Try and talk about feelings rather than arguing over facts.

•Identify yourself by name and call the person by name. Approach the person slowly from the front and give him or her time to get used to your presence.

•Try to talk in a quiet place without too much background noise.

•Speak slowly and distinctly. Use familiar words and short sentences.

•Keep things positive.

•Use gestures, visual cues and verbal prompts to help.