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Treatments for Dementia

Managing Behavioural Symptoms Without Drugs

In Alzheimer's disease and other types of dementia, behaviour can be a problem. One technique for helping to treat problem behaviour in Alzheimer's disease and other forms of dementia has been developed by Dr. Linda Teri and colleagues at the University of Washington in Seattle. In pioneering work over many years, they have emphasized an "A-B-C" approach to behaviour problems.

People who are skilled in that approach emphasize starting by understanding three aspects of the problem: 'B' - the behaviour itself: It is important to describe the behaviour problem well.

Next, you should think about 'A', the antecedents of the behaviour. These are the events that happen just before the behaviour itself. Does the behaviour come on at a certain time of day, or when certain people are present, or in one room more than others, or prior to a specific activity (such as bathing, or meals, or going out). Does the behaviour follow taking a particular drug? Did it all start with a particular life event, such as the death of a loved one, or a move to a new place? Once you understand the events that happen prior to the behaviour, it might be possible to change those events, and then see if the behaviour lessens. (Any drug changes, of course, should only be undertaken in consultation with your physician or other health care professional). You can use the tracking function of the SymptomGuideTM to see how this changes over time.

Some antecedents - the death of a spouse being a tragic, but common example - cannot be changed. This suggests that a more in-depth exploration is helpful - for example, to look for the possibility of an untreated depression . Framing the problem in this way ("Things have not been the same since Mom died. Do you think Dad might be depressed?" or "Mother gets upset every day after breakfast. We've tried changing breakfast and letting her sleep in. What else do you think we might do?") is often a great help to health care professionals in letting them know the situation, and also in letting them know that you have given thought to the problem.

Finally, you can think about the 'C' - the consequences - of the behaviour.

An important thing to remember that can help you cope with problem behaviour is that the behaviour is part of the disease, and not part of the person. The person that you care for is not at fault for doing what they do. Behaviour problems are very wearing on caregivers, so just as the person is not at fault for their behaviour, you are not at fault for feeling angry about that behaviour. This is a very common reaction, and while it needs to be managed, you shouldn't make the situation worse by feeling guilty about it.

Two other points to remember when you are dealing with a problem behaviour in dementia is that, over time, it will often settle on its own. The second is that it is uncommon for the behaviour to go away entirely. Often what we aim for is to reduce the problem by half or more.

Further reading:

Teri L, McCurry SM, Logsdon R, Gibbons LE. Training community consultants to help family members improve dementia care: a randomized controlled trial. Gerontologist 2005;45:802-11.

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Last updated August 21, 2014
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