Peter Rabins, M.D., Director of the Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins offers advice to families caring for a loved one with dementia.
Agitation is common in people with dementia -- it occurs roughly 50% of the time, more often in the middle or later stages of the disease. In fact, managing agitation and other behavior problems account for roughly 30% of all the money spent on treatment for Alzheimer’s disease.
Because many people with dementia can’t adequately communicate the source of their frustration, it is difficult to help them. Peter Rabins, M.D. says, “We think that part of the reason people with dementia become agitated so easily has to do with the effects of disease or injury on brain areas associated with inhibition.
“In people with dementia, damage to the parts of the brain responsible for controlling reactions to frustrating situations or emotional stimuli results in a much ‘shorter fuse.’ Also, dementia renders people unable to think through problems -- to get up and turn down the radio if it is too loud, for example.”
One problem with agitation is the term itself: It tends to refer to a broad range of difficult to manage behaviors. “When talking to a doctor, be as specific as you can about the behavior problem. The more you can tell the doctor about the behavior -- when it first started or where it tends to happen, for instance -- the easier it is to figure out what may be triggering it.”
What to do? Some suggestions:
- Dementia and music -- A study published in the Journal of Gerontological Nursing found that nursing home residents with Alzheimer’s disease who listened to their favorite music were substantially less agitated. Researchers cited music’s unique capacity to conjure up old memories and emotions as the reason for improvement in dementia-related agitation. Other research has found that soothing music helps calm people with dementia even if they are unfamiliar with the songs.
Dementia and art -- Art therapy may be helpful, whether dementiapatients create their own artwork or view artwork in museums -- though few formal studies have been completed. You can learn more about art therapy and other therapeutic activities at www.alzinfo.org/alzheimers-treatment-therapeutic.asp. Or contact your local museum about guided tours for people with dementia.
Dementia and Montessori --The Montessori philosophy applied to patients with dementia focuses on enhancing memory, learning and retaining skills, expressing emotions, and maintaining personality and self-esteem. Small studies have suggested that the Montessori approach reduces depression in people with Alzheimer’s disease. Patients typically participate in structured, hands-on activities in which individual tasks contribute to a larger goal. Activities evolve slowly from one-step tasks to more complex ones, and from concrete experiences to abstract ideas.
Dementia and relaxation techniques -- A summary of two small clinical trials involving a total of 110 participants found that massage and touch therapy temporarily reduced episodes of agitation, anxiety, and depression in people with dementia. To find a practitioner experienced in treating people with dementia, check with local physical therapists, long-term care facilities, or senior centers.
