Moodiness and irritability in Alzheimer’s patients – how to treat it
If you are looking after someone with Alzheimer’s, you may have noticed that they are often moody, irritable or sad. Mood swings and behavioral changes are normal symptoms of this disease, and they can also be the most challenging.
Want to know what treatments are available to help Alzheimer’s patients cope with their mood swings?
Keep reading to find out exactly why these changes are happening, how to better understand what patients are going through and which drug and non-drug treatments can help treat these symptoms.
Changes in behavior are caused by the progressive deterioration of brain cells that is characteristic of Alzheimer’s. However, sometimes there are other factors such as medication, environmental factors and some medical conditions that can cause these changes, or worsen existing behavioral issues.
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What is happening in the brain of someone with Alzheimer’s?
Common behavioral changes in someone with Alzheimer’s
In the early stages of Alzheimer’s, patients may experience changes in their behavior and personality, such as:
- Irritability
- Anxiety
- Depression
In the more advanced stages of Alzheimer’s, other symptoms may appear, including:
- Anxiety and agitation
- General emotional distress
- Physical or verbal outbursts
- Impatience, tendency to rip up paper or tissues
- Hallucinations (seeing, hearing or feeling things that are not there)
- Delusions (firmly belief in things that are not true)
- Sundowning or “late-day confusion” (problems that start at dusk and get worse into the night)
- Difficulty sleeping
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Situations that trigger behavioral changes in patients with Alzheimer’s
Changes to the person’s environment often play an important role in triggering behavioral symptoms.
Change can be stressful for anyone, but often people with Alzheimer’s find it especially difficult to deal with change. Unexpected situations can be distressing for patients, and they may find it difficult to cope, as they are constantly trying to make sense of an increasingly confusing world.
Situations that can affect behavior can include
- Moving to a new house or to a nursing home
- Change of familiar environment or carer
- Situations that seem threatening
- Admission to a hospital
- Asking them to bath or change their clothes
If you can identify what has triggered a change in behavior, it is important that you make a note of it, as this may help you choose a different approach to better manage the situation next time.
Conduct a thorough medical evaluation to determine the factors that are triggering Alzheimer’s symptoms
People who begin to show symptoms of behavioral changes and mood swings should receive a thorough medical evaluation, especially if symptoms appear suddenly.
Although behavioral changes happen due to certain changes that occur in the brain, a medical examination could reveal other contributing factors.
These other factors include:
Side effects of medication:
Many people with Alzheimer’s take prescription drugs for other health problems. Side effects of these drugs or interactions between them can affect behavior.
Discomfort due to an infection or other conditions:
As the disease worsens, people with Alzheimer’s find it increasingly difficult to communicate with others about their experience. Click here to find out how to communicate better with people with Alzheimer’s.
If they are experiencing pain due to urinary, ear or sinus infections, this may cause patients to feel irritable or agitated. They may also express themselves through changes in their behavior if they feel discomfort in their bladder, constipation or if they are too hot or cold.
Untreated hearing problems or poor vision:
This can contribute to their confusion and frustration and make them feel isolated.
Non-pharmacological treatments to help ease behavioral changes in people with Alzheimer’s
Non-drug treatments for managing behavioral changes in people with Alzheimer’s promote physical and emotional wellbeing. You should consider these options before starting any pharmacological treatments.
These treatments are based on identifying and focusing on the needs of Alzheimer’s patients who are unable to express themselves easily.
To effectively implement non-drug treatments, you should:
- Recognize that the person is not just “in a bad mood”, but that they are showing normal symptoms of the disease.
- Identify the cause and how the symptoms may be related to the experience of the person suffering from Alzheimer’s.
- Try to make necessary changes to the patient’s environment to prevent them from running into obstacles or provide them with the tools they need to resolve problems from a comfortable, safe and more relaxed position.
Advice for coping with the behavioral changes that come with Alzheimer’s
Monitor the patients comfort levels:
you should regularly check whether the patient with Alzheimer’s feels pain, hunger, thirst, constipation, fatigue, has a full bladder, or any infections or skin irritation. It is recommended to check that the room temperature is comfortable.
Avoid confrontations or disagreements:
for example, if a patient expresses a desire to visit their mother who died years ago, it is better not tell them that their mother is dead. Instead, you could say: “Your mother is a lovely person, I would like to see her too”.
Redirect the patient’s attention:
try to be flexible, patient and understanding, responding to emotion, not behavior. Remind them of happy moments or feelings that focus on positive emotions.
Create a calm environment:
try to ensure that the patient´s space is free of noise, bright lights, safety hazards or excessive distractions going on in the background, like a TV.
Allow them sufficient rest:
If the patient wants to sleep or isolate themselves, help them to get some rest. Certain events and activities that are normal for you, may be over-stimulating and exhausting for them.
Give them some kind of security object:
this could a blanket, a photo, a bracelet or anything with special meaning for the person that makes them feel safe. Give them this object when they feel irritable or sad.
Acknowledge their requests and respond to them:
we know that it is not always easy to communicate with Alzheimer’s patients, especially those in the more advanced stages of the disease, but it is important that you understand their language. Here you can find information on how to better communicate with Alzheimer’s patients.
Look for reasons that may be causing the behavior:
talk to your doctor about how to identify causes that could be associated with their medication or other illnesses.
Try various solutions:
if one of these tips does not work, try not to get frustrated. Keep exploring other options to help you find a way to treat the patient with love and calmness. You are the one who knows them best and, over time, you will learn how best to deal with them.
Don’t take it personally:
remember that the person is not being rude or aggressive because of you. Their behavior is simply a manifestation of Alzheimer’s symptoms that the patient cannot control.
Medication for behavioral changes in people with Alzheimer’s
If, after trying several non-drug treatment options, your loved one is still showing severe signs of changes in their behavior, which could potentially lead them harm to themselves or others, then you may want to consider starting them on medication.
Prescription drugs can be effective in certain situations, but they must be taken with serious caution, and are usually more effective when combined with the non-pharmacological treatments mentioned above.
Before starting any pharmacological treatment
Before deciding whether to treat these behavioral changes with medication, you should take into account the following instructions:
- Familiarize yourself with the risks and benefits of the medication: you should know the advantages, as well as the potential risks of the drug before making any decisions.
- Target a specific symptom: if the treatment is aimed at a central symptom, other symptoms can be alleviated as well. For example, some antidepressants not only improve the mood of people with Alzheimer’s, but also help them sleep better.
- Start with low doses of a single drug and monitor closely for side effects: side effects can be very serious and, occasionally, can even worsen initial symptoms. Doses should not be raised without carrying out a medical evaluation first.
Example of drugs used to treat behavioral changes in people with Alzheimer’s
It is important to bear in mind that there are no drugs that have been specifically approved by the FDA (US Food and Drug Administration).
The examples listed below can be used to treat other pathologies, but can also be used for purposes such as easing symptoms of behavioral changes in Alzheimer’s patients.
The drugs used to treat these symptoms include:
Antidepressants: for treating sadness and irritability
- citalopram (Celexa)
- fluoxetine (prozac)
- paroxetine (paxil)
- sertraline (zoloft)
- trazodona (Desyrel)
Anxiolytics: for treating anxiety, nervousness, agitation, resistance and verbal aggression
- lorazepam (Ativan)
- oxazepam (Serax)
Antipsychotics***: for treating hallucinations, delirium, aggression, agitation, hostility and refusal to cooperate.
- aripiprazole (Abilify)
- clozapine (Clozaril)
- haloperidol (Haldol)
- olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- risperidone (Risperdal)
- ziprasidone (Geodon)
*** Antipsychotics should be taken with extreme caution and only under specific instructions from a doctor! Research has shown that these drugs are associated with a higher risk of death by stroke in adult patients with dementia.
It is normal to feel overwhelmed when caring for an Alzheimer’s patient who is experiencing behavioral changes. We invite you to share your experiences with us and find support in the huge network of people who are also dealing with this disease.