Related topics: •  Alzheimer's: Dealing With Repetitive Behavior •  Dealing Positively With Alzheimer's Behaviors: Part I •  Dealing Positively With Alzheimer's Behaviors: Part III

Alzheimer's disease causes the brain to deteriorate, causing severe memory loss, confused thinking, and personality changes. As a result, many caregivers find their loved one's behavior can be perplexing, frustrating, and difficult to deal with. But if you understand why the patient is acting in a certain way, you'll be more likely to respond with skill and patience. These step-by-step guidelines are reprinted with permission from Alzheimer's: A Caregiver's Guide and Sourcebook (John Wiley &Sons, 1992) by Howard Gruetzner.

•Behavior: A spouse with Alzheimer's sexual interests and demands are higher than normal or more difficult for you to satisfy.

•Common responses: A sexual relationship is inappropriate in light of the illness. How could he enjoy sexual activity at such a time?

•Alzheimer's interpretation: Brain damage can increase a person's desire for sexual activity. It can also decrease his sexual inhibitions, create difficulties in relating sexually, and reduce sensitivity to his partner. Alzheimer's can threaten a person's sexual identity and self-esteem.

The loss of intimacy that occurs as the disease gradually diminishes the victim's personality may make it difficult for the caregiver to sustain a sexual relationship. The affected person may continue to find sexual satisfaction, but the spouse suffers a loss of emotional satisfaction.

Despite these problems, sexual relations can continue to be important, and they are a matter of personal choice. The person with Alzheimer's needs to feel wanted and loved. Adjustments in relating sexually may be necessary.

Helpful responses

•Understanding changing sexual interests and demands in the context of both the illness and your prior sexual relationship.

•Rely upon touching, being caressed, and nonverbal relating as substitutes for the sex act.

•Talk with a physician or counselor if the sexual problems persist.

•Behavior: The person mishandles her money and monthly bills; she accuses you and others of stealing her money; she claims her banker is handling money matters.

•Common responses: She is inconsiderate and irresponsible; she is unfair and will not face the facts; she is lying and avoiding the issue.

•Alzheimer's interpretation: Having and handling money is one of the symbols of a person's independence and competence. The person may blame others for her mistakes because she is trying to protect her self-esteem and maintain her independence.

Early problems with memory and reasoning abilities make it difficult to handle more complex financial matters. Trying to perform calculations, even on paper, becomes frustrating. Accusing others of taking money is one way in which the person fills the gaps in her memory and protects her self-esteem.

Helpful responses

•Be sure there is no truth in the accusation of theft, particularly when the person lives alone and is vulnerable.

•Let the spouse or adult child assume the responsibility for financial matters.

•Monitor the person's monthly bills and contact creditors about questionable charges.

•Be sensitive to the person's insecurity and fears when discussing financial matters.

•Allow the person to have some cash on hand to enable an easier adjustment of alternative financial arrangements.

•Consider legal arrangements such as power of attorney and guardianship as a means of protecting the person's financial security.

•Behavior: The person tells ridiculous stories or says unusual things.

•Common responses: He is lying or being mean; he is going crazy or senile.

•Alzheimer's interpretation: Such stories are easy to take personally, but they are rarely malicious. As memory and reasoning abilities continue to decline, larger gaps are left in the person's perception of reality. It is harder for him to explain or understand what is happening because his grasp of logic is deteriorating. Ridiculous stories and obvious untruths may be attempts to fill in the blanks, to explain what he cannot understand.

If the person believes his own stories, the things he says may cause real agitation, anger, and fearfulness. If his stories place blame on others, he may be trying to defend his self-respect and integrity.

Some of the unusual things a person says may also represent difficulties in speech. Finding words to explain things or even name things correctly becomes difficult as the disease develops. The person may be able to manage only fragmentary ideas or statements.

Helpful responses

•Clarify and correct the person's understanding of events.

•Respond sensitively to underlying feelings of insecurity, fear, or frustration.

•Avoid overreacting to stories or allowing an argument to start.

•Distract the person with conversation about other things.

•If the person is upset, give him a chance to calm down.

•Behavior: The person repeatedly talks about experiences from the past.

•Common responses: He is living in the past; he does not want to relate to the present.

•Alzheimer's interpretation: Although the brain-impaired person's ability to recall recent experiences is becoming less reliable, he still may remember more remote material from the past. This material remains accessible to the person longer and can provide a more meaningful basis for self-esteem and identity. The present has become more threatening and difficult to accept emotionally. The person may also be losing his ability to relate to time and may be confused about the relation of past to present.

Helpful responses

•Use past memories to make activities in the present more meaningful.

•Provide concrete information that distinguishes the present from the past; for example, contrast pictures of grown up grandchildren with their childhood pictures.

•Set aside time for reminiscing.

•Patiently and supportively orient the person to the present when the confusion is apparent.

First published July 27, 2000
Last updated March 6, 2008
Copyright © 2000 Consumer Health Interactive

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