Alzheimer’s Symptoms Often Manageable without Drugs

  • Alzheimer’s disease cannot as yet be prevented or cured. While there are some medications that may help some people with the symptoms of the disease, they have drawbacks. With this in mind, some experts feel that many symptoms of the disease are better treated with behavior interventions.


    An article on reports on the work of Johns Hopkins University School of Nursing (JHUSON) professor Laura N. Gitlin, PhD and her colleagues. These scientists are promoting the concept that if physicians integrate behavioral management strategies into early ongoing treatment, behavior changes can be controlled.

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    Confusion, repetitive questioning, combativeness and loss of inhibition are frustrating behaviors for caregivers to cope with. In addition, wandering and hallucinations can also carry a risk of injury to the person with the disease. All of these symptoms affect the quality of life of both the person with the disease and the family caregiver. Physicians have been challenged to come up with solutions, but according to these scientists, many available medications are only marginally effective and they often carry significant risks.


    The Johns Hopkins team feels that screening for early manifestations of behavioral symptoms is not as routinely conducted as it should be. They add that the “risk factors for behavioral occurrences may be missed and ultimately precipitate placement in a nursing home or other costly long-term care facility.”

    In “Nonpharmacologic management of behavioral symptoms in dementia,” published in the Nov. 22 issued of Journal of the American Medical Association, the authors outline a six-step approach to help clinicians identify and effectively manage most behavioral symptoms of dementia:


    • Screen for behavioral symptoms early.
    • Identify symptoms.
    • Delineate the triggers and risk factors for the symptoms.
    • Choose the proper interventions. For example, an individual with dementia might wake repeatedly each night, voicing fear of being alone in the dark, despite continuous calming efforts.   An intervention might mean simply using a nightlight in the patient’s room, or adding long family walks in the evening, to help promote better sleep.
    • Evaluate the intervention to make sure that it’s working.
    • Follow the patient’s progress over time.


    The authors state that this six-step approach should be a physician’s treatment of choice, when possible. The Johns Hopkins group encourages physicians to educate families and caregivers about the behavioral symptoms they may face in their loved ones. If caregivers are provided with tools and strategies to prevent or cope with challenging behaviors, everyone benefits.


    Low-tech interventions such as breaking daily activities into small, simple steps, sticking to structured routines and learning to divert the person from dangerous activities such as wondering can also reduce healthcare costs and emergency visits to the hospital. Hospitalization can create more anxiety and fear, so anything the caregiver can do at home to avoid emergency situations is positive.


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    Guidance from other experts

    The Alzheimer’s Foundation of America and the National Alzheimer’s Association both have websites packed with educational material to help family caregivers cope with dementia related behavioral issues.


    Both sites spend significant time explaining terms like validation, where caregivers learn to help the person with the disease feel that they can have opinions without being criticized. Distraction and redirection are other classic tools taught by Alzheimer’s experts. By distracting a person with AD from something dangerous and redirecting him or her to something comforting – say watching a familiar old movie on DVD or listening to music – many difficult times can be averted.


    Naturally, caregivers won’t always be successful when using these techniques. Alzheimer’s disease and other dementias are very challenging, and some people are harder to manage than others. Medical intervention is often needed. However, by working with the physician to utilize the six-step program promoted by the Johns Hopkins group, and following some of the advice on the Alzheimer’s support sites, life can be made easier for most people affected by the disease.


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    Johns Hopkins University School of Nursing (2012, November 21) Six Steps to Reduce Dementia’s Most Troubling Symptoms. Retrieved from

Published On: November 28, 2012