It's certainly not uncommon. AD generally leaves people confused and often afraid. Your mother may be going through a period of being terrified because she doesn't understand her surroundings, or else she may be having thoughts that frighten her. The fact that she is exhausted afterwards makes sense. I'd encourage you, however, to share this with her doctor. There is likely something more that can be done for her.

Carol

Hi, Lin da,

This seems to be common. In their wonderful book, "The 36-Hour Day", Nancy Mace and Peter Rabins note that peopoelw ith brain diseases may experience rapidly changing moods and can become excessively upset, even overreacting. They call the term "catastrophic reaction," noting that the reaching may seem inappropriate over such a little thing.

My mom also experienced outbursts of rage. I experienced her rage one time immediately prior to her diagnosis with Alzheimer's. She was staying with me after experiencing severe health problems. I was really focused on trying to stabilize her health as well as work and attend graduate school. She got picky about my not dusting the dining room table (which was passed down to me from her aunt). I lost my temper (which I seldom do) and told her that I would dust it but in the grand scheme of things, a thin layer of dust was not the most important thing in my life right then. She was fine then, but had a major outburst later that day. I had gone to school and had hired an aide to sit with her. Midway through class, my cell phone rang. I went out in the hallway and answered. It was the aide saying my mother wanted to talk to me. Mom got on the phone and said, "If you don't get home in 10 minutes, I'm going to start breaking things." She was yelling at me so loudly that others could hear her. I was stunned, and assured Mom I would be home shortly. When I got home, she preceeded to disown me and told me that I had to ship the table and other items to her back in West Texas (where she and Dad had lived) the next day. I left the room to let her cool down. A short bit later, she was friendly again, asking me to take her dog out before she went to bed.

After this experience, I developed a hypothesis that seemed to hold up (at least in Mom's case). I believe that people with Alzheimer's really take their cues from our emotions and then adopt those behaviors. I found that if I visited Mom in the nursing home and she was in a rage, she'd calm down if I'd wheel her to another area and then sit calmly with her. I learned to adopt a "Zen attitude" that seemed to diffuse her rage.

I hope this helps. Take care and keep us posted!

Dorian

Carol Bradley Bursack, Health Guide

9/ 2/12 10:03am

What an enlightening story, Dorian! I think people with all types dementia are apt to take some of their cues from their caregiver, including our body language. That's why it's so important to step away, as you did. To see your mom act like that had to be painful. I had similar situations, though it was because of other types of dementia. Painful stuff, but we learn and hopefully can help others through our experiences.

Blessings,

Carol

First and foremost, if there has been a noticeable change in your mother’s mood or behavior, and sleeping patterns, I recommend that she be evaluated by her physician.  There are several treatable medical conditions such as urinary tract infections, vitamin deficiencies and depression that can worsen the symptoms of Alzheimer’s disease. Sleep issues, likewise, could be impacted by medications she might be taking, her daily routine, her level of stimulation, and the disease process. I would advise that you consult with your mother’s physician to rule out possible medical causes and to see if her medications need adjustment.  If there is a medical problem that could be contributing to these changes, it needs to be addressed right away.

There are certain behavioral symptoms that are characteristic of Alzheimer’s disease that appear in many individuals. These include changes in personality, unexplainable mood swings, loss of initiative in starting or completing activities, aggression, agitation, and depression. People with Alzheimer’s disease tend to experience cognitive symptoms like confusion and disorientation, which can influence their perception of reality. If their judgment is impaired, they may have trouble distinguishing right from wrong, and it’s not uncommon for them to take their aggression out on people around them. Your mother may not have control over her behavior, and is likely to even forget minutes after an outburst. The confusion can manifest in many ways, such as wrongly identifying a family or friend or attacking others because she does not recognize them, or negatively associates them with someone from her past.

Your first step with dealing with your mother’s aggression is to assess the situation to protect yourself and her. Should her aggression become violent or physically dangerous, it is essential to always assure safety for yourself and the individual. Remaining calm while also providing reassurance can help the aggression subside in the hope to regain everyone’s composure. In regards to your mother having “outburst and rage” it is important to try and understand what your mother may be experiencing.  Sometimes individuals may lose their ability to verbalize their thoughts or feelings and as a result, may act out their feelings physically. Other individuals can become so frightened of their surroundings that they respond aggressively as a way of protecting themselves. Aggressive outbursts are not uncommon for people with dementia and should be treated with care and sensitivity.

Often individuals with Alzheimer’s disease become aggressive when one of their basic needs have not been met.  It is possible that your mom is no longer able to verbalize what she needs and the aggressive behavior is the only way she can let you know that something is wrong.  When your mother becomes aggressive, ask yourself the following questions:

• Is she hungry or thirsty?
• Does she need to use the bathroom?
• Is it too hot or too cold?
• Is she bored?  Can I engage her in a pleasurable activity?

You may not be able to control how your mother behaves, but you can control how you react to her agitation. Try to validate her feelings; it can help her decrease her agitation. Many times, people with Alzheimer’s disease are so frustrated that they act it out through verbal abuse and aggression. Try to put yourself in her place, and this can help you remain calm when caring for her. Also, it is important to realize if the methods you use are not working, it’s ok. I suggest taking yourself away from the situation and letting your mother calm down and relax, then reproach the situation.

Carol Bradley Bursack, Health Guide

9/ 5/12 8:46am

Thank you for this excellent response. AFA rocks!

Carol