A change in behaviors can be very unsettling to the caregiver.  Let’s explore behaviors: the better you understand WHAT the behaviors are,the easier it will be to speak to your doctor about the potential CAUSE.

Hallucination

The individual SEES, HEARS, TASTES, SMELLS or FEELS something in absence of the actual object. For example, your mother is talking to “someone” (although noone is actually there) that she SEES in front of her. It may or may not be disturbing to her. Often an individual may see a deceased parent or spouse.  The hallucination may be related to a former occupation.

The same applies for the other senses. They hear babies crying or see children playing. They may taste or smell a certain food. Again, this is in absence of the actual item. This is not just believing something is happening, the individual must actually see, hear, taste, smell or feel it. It is not just a mistaken belief, or a misinterpretation (such as seeing a fallen limb and believing it is someone lying on the ground).

It should be noted that feeling something is less common, such as feeling someone touching you, or perhaps feeling their deceased spouse beside them in bed.

Delusions

Simply explained, a delusion is a false belief. A person may believe their parent is in the house, when in fact they passed away many years ago. They may believe their children will be home for dinner, while you know they are grown and away from home.

An individual may also state that their house is not their home, repeatedly asking to “go home”. They may not believe that their spouse or children are who they say they are, stating they are not married, or do not have children.

Another common delusion, as noted in the hallucination, may be related to a former occupation.  Insisting, even though they have long since retired, they have to get to an important meeting, or have chores to do in the barn.

There are also times when individuals believe that the characters on television are real, and talking directly to them. They may interact with the characters. This may or may not be a positive experience, depending on the television show. As well, they may incorporate some of the stories into their own lives, believing that this is happening in their own lives.     

Caregivers will often become alarmed as their loved ones are “telling stories”, believing they are in danger, a loved one is stealing from them, or someone is going to “put them away.” It is, unfortunately, not an uncommon experience for the police to receive a call from an individual with just such statements. It is, as is expected, often embarrassing  or disturbing for the caregiver.

Some delusions are disturbing, causing anxiety and paranoia. Others in fact may be calming and pleasant.

Changes in mood: anxiety and depression

Anxiety can present itself in many different fashions, at various points of the day as well as in a variety of situations. The individual may experience some slight restlessness or as pronounced as pacing, wandering, sometimes with even physical symptoms such as an upset stomach or tearfulness due to fear.

There are some common times of anxiety, one of which I call the “witching hour” otherwise known as “sundowner’s syndrome”. This generally occurs in late afternoon or early evening, as the sun sets. There are many thoughts about this phenomena, some of which are as follows:

In the late afternoon, (as I identify it: “the witching hour”) an individual may be tired, restless and even a bit hungry. They are unable to express what they are feeling. They may begin to pace, become agitated and sometimes downright unpleasant. Of course all of this occurs as you are just arriving home from work, trying to fix dinner or wind down from a busy day. note:The phenomena is identified here, solutions to come in abit.

Sundowner’s syndrome is as it states. Shadows increase, nothing looks like the same when lights are turned on and the individual has a feeling of fear and/or restlessness. Often times they may be fearful of someone being outside, perhaps seeing their own reflection in the window and not recognizing themselves. Shadows from lamplight become objects of fear, creating anxiety.  These can be very unsettling to the individual and overwhelming for the caregiver.

Depression: Clinical depression is known to be a persistent feeling of depression (intense sadness) for more then 2 weeks. However, a dementia patient may have sadness and or depression that waxes and wanes, meaning it comes and goes. There may be many reasons for this. In the early stages of a disease process, they may be aware of the changes that are occurring, and very sad/depressed about their health status. Fears of what is to come, especially if they have cared for someone with a similar disease. They may be unwilling, or unable to talk about their feelings, increasing the emotional toll.
As well, with some diseases, such as a stroke or Parkinson’s disease, the depression may be part of the disease itself. In addition, some medications have a side effect of depression. All issues to discuss with your physician.

Sleep

This is often a very difficult issue for caregivers.
Sleep disorders can range from difficulty falling asleep, not staying asleep, up at odd hours believing it is daytime, or rising too early.

Sleep issues arise for many reasons. First, check with your doctor to ensure there is no medical issue occurring. Never assume any change is simply a product of the dementia, even if that may be the case. Your provider knows your loved one's entire medical history, and may have other suggestions in regards to promoting sleep.

Next, is the person sleeping very frequently during the day?  Although this time may provide "respite" for the caregiver, it may also disrupt an individual's sleep pattern at night. This is often a difficult, but certainly not impossible, pattern to change. A few general suggestions about sleep:

• Keep the individual engaged during the day if possible as sometimes sleep is due to boredom.
• Promote exercise and/or walking during the day, if it is safe, to help them sleep better at night.
• In the winter, when the days are short, often times individuals with cognitive disorders want to go to bed as soon as it is dark outside.  Try and keep them up as long as possible by engaging them in an activity.
• A little exercise after dinner, like music and dancing (if the person can safely dance), can help invigorate them abit in the evening, keeping them up a little longer (and it's fun).

We will be adding more suggestions to this section over time. We understand that many of these ideas may not seem to fit your situation, and that's okay.  Try and think of things that will work for you and your loved one.