Treatments for Behavior

In addition to affecting memory and other

cognitive skills, Alzheimer's disease often
affects the way people feel and act.

Behaviors
Triggers
Medical factors

Non-drug approaches
Coping tips
Medications

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Common changes in behavior

Many people find the changes in behavior caused by Alzheimer's to be the most challenging and
distressing effect of the disease. The chief cause of behavioral symptoms is the progressive deterioration of
brain cells. However, medication, environmental influences and some medical conditions also can cause
symptoms or make them worse.
In early stages, people may experience behavior and personality changes such as:

Irritability

Anxiety

Depression

In later stages, other symptoms may occur including:

Anger

Agitation

Aggression

General emotional distress

Physical or verbal outbursts

Restlessness, pacing, shredding paper or tissues

Hallucinations (seeing, hearing or feeling things that are not really there)

Delusions (firmly held belief in things that are not true)

Sleep disturbances

Learn more: Behaviors and Caregivers and Coping

Help is available
Your local Alzheimer's Association chapter can connect you with the
resources you need to cope with the challenges of Alzheimer's. Find a
chapter in your community
Our free 24/7 Helpline provides information, referral and care consultation
by professionals in more than 200 languages.
Our Greenfield Library houses more than 5,000 books, journals and
resources. Access it online.

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Triggering situations
Events or changes in a person's surroundings often play a role in triggering behavioral symptoms.
Change can be stressful for anyone and can be especially difficult for a person with Alzheimer's disease. It can
increase the fear and fatigue of trying to make sense out of an increasingly confusing world.
Situations affecting behavior may include:

Moving to a new residence or nursing home

Changes in a familiar environment or caregiver arrangements

Misperceived threats

Admission to a hospital

Being asked to bathe or change clothes

Identifying what has triggered a behavior can often help in selecting the best approach to deal with it.

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Medical evaluation for contributing factors

Everyone who develops behavior changes should receive a thorough medical evaluation, especially if

symptoms appear suddenly.

Even though the chief cause of behavioral symptoms is the effect
of Alzheimer's disease on the brain, an examination may reveal
other treatable conditions that are contributing to the behavior.
Contributing conditions may include:

Drug side effects. Many people with Alzheimer's take

prescription medications for other health issues. Drug
side effects or interactions among drugs can affect
behavior.

Difficulty with
communication
Because people with Alzheimer's
gradually lose the ability to
communicate, it's important to
regularly monitor their comfort and
anticipate their needs.
Learn more: Communication Tips

Discomfort from infections or other conditions. As

the disease gets worse, those with Alzheimer's have
increasing difficulty communicating with others about their experience. As a result, they may be unable
to report symptoms of common illnesses. Pain from infections of the urinary tract, ear or sinuses may
lead to restlessness or agitation. Discomfort from a full bladder, constipation, or feeling too hot or too
cold also may be expressed through behavior.

Uncorrected problems with hearing or vision. These can contribute to confusion and frustration and
foster a sense of isolation.
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Non-drug approaches
Non-drug approaches to managing behavior symptoms promote physical and emotional comfort.
Many of these strategies aim to identify and address needs that the person with Alzheimer's may have difficulty
expressing as the disease progresses. Non-drug approaches should always be tried first.
Steps to developing successful non-drug treatments include:

Recognizing that the person is not just "acting mean or ornery," but is having further symptoms of the
disease

Identifying the cause and how the symptom may relate to the experience of the person with Alzheimer's

Changing the environment to resolve challenges and obstacles to comfort, security and ease of mind
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Coping tips

Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections
and skin irritation. Maintain a comfortable room temperature.

Avoid being confrontational or arguing about facts. For example, if a person expresses a wish to go
visit a parent who died years ago, don't point out that the parent is dead. Instead, say, "Your mother is
a wonderful person. I would like to see her too."

Redirect the person's attention. Try to remain flexible, patient and supportive by responding to the
emotion, not the behavior.

Create a calm environment. Avoid noise, glare, insecure space and too much background distraction,
including television.

Allow adequate rest between stimulating events.

Provide a security object.

Acknowledge requests, and respond to them.

Look for reasons behind each behavior. Consult a physician to identify any causes related to
medications or illness.

Explore various solutions.

Don't take the behavior personally, and share your experiences with others.

Our online social networking community can also help you. Join AlzConnectedand learn tips for coping with a
loved ones behavior and find support from other caregivers.

Medications for behavioral symptoms

If non-drug approaches fail after being applied consistently, introducing medications may be
appropriate for individuals with severe symptoms or who have the potential to harm themselves or others.
While prescription medications can be effective in some situations, they must be used carefully and are most
effective when combined with non-drug approaches.
When considering use of medications, it is important to understand that no drugs are specifically approved by
the U.S. Food and Drug Administration (FDA) to treat behavioral and psychiatric dementia symptoms. Some of
the examples discussed below represent off label use, a medical practice in which a physician may prescribe a
drug for a different purpose than the ones for which it is approved.
Learn more: Antidepressants (for mood), Anxiolytics (for anxiety/restlessness), Antipsychotic medications (for
hallucinations)

Guiding principles
The following general principles can help guide appropriate use of
medications:

Know the risks and benefits. It's important to understand the

potential benefits and risks of a medication before making treatment
decisions.

Target a specific symptom. Effective treatment of one core

symptom may help relieve other symptoms. For example, some
antidepressants may help people sleep better.

Start with a low dose of a single drug and monitor closely

for side effects. Side effects can be serious, and drugs can
occasionally even worsen the symptom being treated. Dosage should
not be increased without a careful evaluation by a healthcare
professional.

Learn more: Alzheimer's Association Statement Regarding Treatment of

Behavioral and Psychiatric Symptoms

Medication examples
Some medications commonly used to treat behavioral and psychiatric symptoms of Alzheimer's disease, listed in
alphabetical order by generic name, include the following:
Antidepressants for low mood and irritability:

citalopram (Celexa)

fluoxetine (Prozac)

paroxeine (Paxil)

sertraline (Zoloft)

trazodone (Desyrel)

Anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance:

lorazepam (Ativan)

oxazepam (Serax)

Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and

uncooperativeness:

aripiprazole (Abilify)

clozapine (Clozaril)

haloperidol (Haldol)

olanzapine (Zyprexa)

quetiapine (Seroquel)

risperidone (Risperdal)

ziprasidone (Geodon)

Antipsychotic Medications
The decision to use an antipsychotic drug needs to be considered with
extreme caution. Research has shown that these drugs are associated
with an increased risk of stroke and death in older adults with dementia.
The FDA has ordered manufacturers to label such drugs with a black box
warning about their risks and a reminder that they are not approved to
treat dementia symptoms.
Learn more: FDA's Safety Alert About Antipsychotics

Based on scientific evidence, as well as governmental warnings and guidance from care oversight bodies,
individuals with dementia should use antipsychotic medications only under one of the following conditions:
1. Behavioral symptoms are due to mania or psychosis
2. The symptoms present a danger to the person or others
3. The person is experiencing inconsolable or persistent distress, a significant decline in function or
substantial difficulty receiving needed care
Antipsychotic medications should not be used to sedate or restrain persons with dementia. The minimum
dosage should be used for the minimum amount of time possible. Adverse side effects require careful
monitoring.
Although antipsychotics are the most frequently used medications for agitation, some physicians may prescribe
a seizure medication/mood stabilizer, such as:

carbamazepine (Tegretol)