Behavioral abnormalities in the context of dementia – a completely underestimated clinical picture. Today, more than 1.2 million German citizens already suffer from dementia. 800,000 of them have severe behavioral abnormalities, such as aggression in words and deeds, sudden mood changes, distrust of family members, restless wandering at night. As the number of elderly people is growing rapidly, experts expect dementia to increase to 2.3 million by 2030, which also means that there are more affected relatives who have to deal with this disease and its high level of suffering. Dementia in old age is thus the health and sociopolitical issue of the future.
Dementia – a burden for all
In Germany, too little attention is still paid to behavioral problems. Often the “grumpy” behavior of the elderly is excused with the increasing age of the patient and dismissed as “normal”. The fact that aggressiveness, restlessness, mistrust, scolding and shouting hide an independent clinical picture is still largely unknown in Germany. In England and the USA, these symptoms are already understood as a disease and patients are treated accordingly. It is to be hoped that this rethinking process will also be set in motion rapidly in Germany in the future. The gradual progressive loss of cognitive performance and thinking ability is one side of a dementia disease. The symptomatology, most commonly known as Alzheimer’s disease, is already in itself an almost unbearable burden for the family, who have to watch a loved one deteriorate mentally more and more before their eyes, no longer able to react in a self-determined manner and increasingly dependent on the help of others.
Behavioral disorders often break up families
But dementia is a “Janus-faced” disease: even more serious are the behavioral changes that accompany dementia, which have the greatest impact on family life together. When a loved one suddenly becomes aggressive, distrustful, and hostile toward his or her closest relatives, when he or she develops delusions, the already arduous caregiving is further complicated by the enormous emotional burden. Often, these very behavioral changes are the reason for institutionalization, thus uprooting the patient from his or her familiar surroundings, with the result that insecurity, aggression, and helplessness are intensified.
The most common behavioral disorders are:
Restlessness / wandering / restlessness: this is a typical phenomenon in dementia patients. Changes in the drive are often the first sign of the disorders in the brain. The affected persons are driven by an inner restlessness, they want to do something continuously, but without knowing what they actually wanted to do. They run around, forget what they wanted to do and start another activity. Disturbed sleep/wake rhythm: Many dementia patients suffer from sleep disturbances. They wander around in the dark during the night. Relatives also can’t sleep because of fear and concern about accidents and injuries. Unlike those affected, who then sleep during the day, they can no longer catch up on their sleep. Aggression and anger: dementia patients often behave aggressively – for no apparent reason for the relatives – and not only with words, but also with actions. This behavior is usually triggered by fear or even anger at having to ask for something that is actually taken for granted. Distrust and hostility: Dementia patients suddenly distrust friends, acquaintances and relatives, they react to them in a hostile and rejecting manner. Even the closest relatives, for example, are suspected of having stolen something from them, of having “stolen” something. Dejection and depression: Depressive moods – caused by mental deterioration – are very common. Many of those affected notice that “something” is no longer right with them. They can no longer cope with their environment and know very well that they are dependent on the help of others. This makes them depressed and sad, without being able to change anything about their condition.Hallucinations / Delusions: Dementia patients often have sensory delusions (hallucinations), meaning they see something that does not exist, they hear voices and sounds that do not exist, or they smell something that the family is not able to perceive. Many of those affected also suffer from delusions: For example, they accuse their relatives of theft, they feel pursued by strangers, and they no longer recognize themselves in the mirror and believe that a stranger is standing opposite them.
Pay attention to first warning signs
Behavioral abnormalities, in particular, usually become apparent two to three years before a diagnosis of dementia is made. In many cases, behavioral disorders are dismissed as “normal” side effects of aging, when in fact they are the first warning sign that dementia may be imminent. The earlier dementia is diagnosed, the earlier adequate therapy can be initiated. And this is where the relatives are called upon. As soon as you notice the first signs of a change in behavior, you should visit the family doctor with the person affected, who can obtain clues to the diagnosis with simple tests. Even if this is often difficult, because the person affected usually lacks insight into the illness, you should insist on the visit to the doctor. This is in your own interest, because even if it is not yet possible to cure dementia, symptoms such as aggression, mistrust, disturbed sleep-wake rhythm, etc. can be effectively reduced or even eliminated. In this way, the therapy gives the affected person the opportunity to influence his or her life plans as long as he or she is still mentally capable of doing so.
