Alzheimer's aggression: When disease triggers angry behavior
As I sped along the 10 Freeway toward a rapidly setting sun, an explosive grinding noise erupted to my right. My car swerved wildly, sliding across two lanes toward the center divider. I grappled with the steering wheel trying to regain control and glanced quickly toward my dad, sitting next to me. In the fading light, I could see what had caused the problem: He had grabbed the gearshift and jerked the car into neutral.
“Let go!” I screamed. For a moment, we tussled over the stick, then I pulled it from him, jamming the car back into gear. “You can't do that while I'm driving,” I yelled. I took a deep breath, trying to calm down, and turned on the dome light. “It's me, your daughter Rosemary,” I said quietly.
He looked at me and blinked, suddenly aware of what he had done. “I didn't know it was you,” he said.
My dad, 91, had zoned out. The incident was a result of dementia, a disease that had left him con-
fused and suffering from a dual personality.
Ninety percent of the time, he was the same wonderful man who had taught me how to ride a bike, dance a waltz and drive a car. He was friendly, compassionate, polite, understanding. The other 10% of the time, his behavior was irrational and sometimes aggressive.
Experts say it's unclear why aggressive or violent behavior sometimes develops among people with Alzheimer's and other forms of dementia. My near-accident in the car seems to be a relatively common phenomenon.
Contrary to stereotypes, the aggressors aren't always male. “I've seen tiny, frail-looking women do some serious damage,” Olsen said.
What causes the violence? According to the Alzheimer's Assn., the behavior may be traced to fright or confusion. Patients may be frustrated because they can't understand others or make themselves understood. Or the disease may have eroded their judgment and self-control.
“Sometimes they misperceive things,” said Olsen, using as an example: “I put my purse right here. Someone must have hidden it from me.”
When the world is confusing, people sometimes lash out or act out, she said. The result may be verbal abuse, kicking, pinching or the occasional violent outburst aimed at people or property.
My dad occasionally drove his fingernails into my hand, pulled a necklace until it broke or squeezed my arm until I bruised. The injuries were all minor, and I don't think Dad would have seriously hurt me. But I was frightened enough to hide the knives in the kitchen.
I kept reminding myself that the disease was causing him to act this way. Life went on. He was happy with the caregivers who helped him during the day and usually happy with me when I took over after work. There weren't many problems.
In retrospect, I realize that when things went badly, I didn't handle the situation as well as I could have. I usually tried to explain things to him or reason with him, which didn't help.
Olsen tells clients to remember the acronym ARE, which stands for:
Do not argue.
Do not reason.
Do not explain.
She also advises to try to anticipate problems. My dad's outbursts always took place late in the day, a syndrome called “sundowning.” It often results in agitation and increased confusion; some experts say it is caused by overexertion.
To counter it, I should have avoided confusing activities, such as trips in the car, at this time of day.
Olsen suggests tranquil diversions: letting the person listen to soft music, watch a DVD that he or she likes or perhaps perform a simple chore.
And if the going gets especially rocky? “Leave the room,” Olsen says. “Close the door, and call for help. You need someone to diffuse the situation — a neighbor, a friend, a family member. Perhaps even the police.”
The bottom line is to make sure you're safe. That's the best thing you can do — for both of you.
The Alzheimer's Assn. suggests strategies for coping with aggressive or violent outbursts. You also can call its 24-hour hotline, (800) 272-3900. Among the organization's tips:
Stay calm. Don't get upset, and don't take it personally. Be positive and reassuring.
Back down. You can't negotiate with a person with dementia. If the person doesn't want to bathe or undress, let it go.
Apologize. It doesn't matter whose fault it is, take the blame.
Avoid using restraint or force. Unless the situation is serious, avoid holding or restraining the person. That will only add to his or her frustration.
-- Rosemary McClure
McClure writes "It's All Relative," our column on caring for and staying connected with aging parents. We welcome suggestions for subjects of future columns: firstname.lastname@example.org.
Illustration credit: Wes Bausmith / Los Angeles Times