How to Understand Alzheimer's Behavior

A person with Alzheimer's disease may sometimes act in ways that are upsetting or seem aggressive. He or she may hit, scratch, or fight with the caregiver. This does not always happen. But if it does, it is likely to be when the person is in the middle stage of Alzheimer's disease. This stage can last for up to four years.

These actions can be upsetting and are often hard for caregivers to manage. It helps to have a plan. One that many people find easy to remember is called ABC. Here is what this means:

• A means Antecedent. This refers to events that happen just before an upsetting action.
• B is the Behavior. This means any upsetting or aggressive action done by the person who has Alzheimer's disease.
• C refers to the Consequence. This includes events that happen after the behavior. Sometimes, these events can make the situation worse.

Here's an example. Mary is the caregiver for her husband, Robert, who has Alzheimer's disease. As you will see, in this story many things go wrong.

A. The Antecedent. What happened before the behavior?

Mary slept too late and now is in a hurry. She wants her husband Robert to quickly get out of bed, take a shower, eat, and get dressed before a driver arrives to take them to his doctor's appointment. Because of her late start, Mary yanks off the bed covers and yells at Robert to get up. He does not understand the words but reacts to her tone of voice. Mary gets angry when he pulls the bed covers back up. "So that's the way it will be. I'm in charge here," she yells.

Mary then drags Robert out of bed and rushes to get him dressed. Now he must balance on one leg rather than sit down to pull up his pants. This is not their usual routine when Mary takes her time helping Robert get ready for the day.

B. The Behavior.

Robert loses his balance because Mary is rushing him so much. He grabs her arm for support and does not let go. When she yells, he grabs even tighter. Robert is now digging his nails into Mary's arm.

C. The Consequence. The events that followed the behavior.

Mary loses control and smacks Robert in the face (something she had never done before). He hits her back. Mary thinks he is fighting, though it may be that he is just afraid and doing to her what she did to him.

 

One problem leads to others and Mary now worries that Robert will hurt her again. She questions whether she can care for him at home and wonders whether Robert must go to a nursing home.

 

Now let's look again at this example using the ABC way. Mary can see that the problems started when she rushed around and did not think of how Robert would react. She now knows she must avoid these types of situations.

• Mary learned that because Robert has Alzheimer's disease, he cannot be rushed. While she should not feel guilty, she should realize how her actions made this worse.
• If Mary is ever late again, she will call the doctor's office and ask if they can make a new appointment or come in later in the day. This is better than expecting Robert to change his behavior.
• Mary will make a list of what happened just before Robert's upsetting behavior. She will look for causes of what went wrong and figure out ways to avoid them.
• Mary will also think about her own actions and what did or did not work well.
• Mary will use the ABC way to help Robert to be more cooperative in the future. This is a way to understand what happened, and figure out ways to better manage in the future.

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