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Emotional highs and lows are burdensome to people living with dementia and their caregivers alike. Here are five common emotional challenges in dementia and how you can deal with them.

What kinds of changes in emotions can you expect in someone who is living with dementia? And how can you deal with them? Here are five common emotional issues with people who have dementia and how you can cope with them.

Handling angry outbursts

Anger is a common emotion in people who have dementia. It may seem to come out of nowhere, but often there is something with activities of daily living or in the environment that wouldn't be frustrating for most people, but that is very frustrating for someone who has dementia. Sometimes people who have dementia blow up when a caregiver tries to help them because they are reminded that they can't perform a task on their own. Sometimes people who have dementia "lose it" when they are confronted with too many new things all at once, or when they are surrounded by people, or when there is too much noise or visual stimulation. 

To prevent angry outbursts during daily care, don't just ask if it's OK if you do something for the person in your care. Don't explain a complicated task all at once.Break down the task into steps and invite their decisions as you go along. And when necessary, give someone who has dementia time to calm down before proceeding with another activity.

Dealing with clinging and dependency

Clinging to familiar people, familiar locations, and familiar objects is a coping mechanism people who have dementia develop to deal with the anxiety that comes from not being able to process information, both new and old. Clinging can manifest itself as hiding and "losing" things, denial of new realities of housing or social contact, failure to accept rejection, or crying, screaming, or rummaging through belongings.

The best thing you can do for someone who exhibits dysfunctional clinging behaviors is to remind them how much you care. When you can't be there as much as they would like, you can leave them notes that remind them when you will be back.

Defeating depression

Depression is only to be expected in people who lose contact with their family and friends as they can do less and less on their own. However, different kinds of dementia produce different rates of depression. Depression is more common in people who have Lewy body disease than in people who have Alzheimer's. Some of the symptoms of depression and dementia overlap. Both conditions can cause apathy, sleep problems (either getting too little sleep or not getting enough), and memory loss.

Sometimes dementia seems to reverse itself (although it really doesn't) when people lift out of depression. You can help by staying aware of the symptoms of depression, and bringing them to the attention of the doctor for further care. 

There is some evidence that episodes of untreated depression earlier in life are associated with greater frequencies of dementia later in life. Treating depression may even be one way to prevent dementia.

Managing mood swings

Mood swings become more common as people who are living with dementia lose their filters for appropriate behavior. Emotional volatility is especially common in frontotemporal dementia. Sometimes mood swings occur because the person is hot, cold, hungry, or in pain and lacks the ability to ask for help. Mood swings can be triggered by too much caffeine or too much (or in some cases, too little) sugar. Clutter, noise, and excessive stimulation can set off roller coaster emotions.

It helps caregivers to remember that mood swings are caused by dementia and are not something caused by the caregiver.

The better you know someone who has dementia, the easier it is to help them. Get to know their likes and dislikes and what they feel is absent in their lives. Sometimes people who have dementia simply forget that they have things that they want. Remind them. Be aware of mood swings associated with sundowning. Keep track of the people and situations that set off sudden changes in mood, both good and bad, and do your best to manage their impact of the person you are giving care.

Pacifying paranoia

Paranoia that results in refusing help is not unusual in dementia patients. As a general rule, the less the disease affects memory, the greater the risk of paranoia, delusions, and hallucinations. Paranoia is relatively common in Parkinsonian dementia and Lewy body disease, and less common in Alzheimer's. People who suffer paranoia become easily offended. They assign harmful meanings to the actions and words of others. They lose their ability to confide in family and friends, and they don't make reasonable compromises. They may become true believers in conspiracy theories promoted through the media, or they may create their own conspiracy theories about the people who take care of them.

Paranoia is the brain's attempt to make sense of confusing information. Too many nursing homes with limited staff manage paranoia with medications such as Haldol and Seroquel, with PRN (as needed) orders to relieve burdens on nurses. Ironically, caregivers may add medications for paranoia to food and drink (this practice is even recommended in Europe), sometimes adding to  the patient's concern. 

It's never a good idea to argue facts with someone who is paranoid, especially when their fears are of plausible events (for example, a child they never see is eager to inherit, not that their nurse has been taken over by body-snatching space aliens).  You won't win a rational argument with an irrational person. You can offer sympathy for their fear, however, and allow them to interact with you bravely and positively.

  • Bennett S, Thomas AJ.Depression and dementia: cause, consequence or coincidence? Maturitas. 2014 Oct. 79(2):184-90. doi: 10.1016/j.maturitas.2014.05.009. Epub 2014 May 29.
  • Chandra SR, Issac TG, Korada SK, Teja KV, Philip M.Neuropsychiatric Symptoms in a Cohort of Patients with Frontotemporal Dementia: Our Experience. Indian J Psychol Med. 2016 Jul-Aug.38(4):326-30. doi: 10.4103/0253-7176.185960. PMID: 27570344.
  • Mendez MF, Shapira JS, Woods RJ, Licht EA, Saul RE. Psychotic symptoms in frontotemporal dementia: prevalence and review. Dement Geriatr Cogn Disord. 2008. 25(3):206-11. doi: 10.1159/000113418. Epub 2008 Jan 17.
  • Photo courtesy of SteadyHealth

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