Dec 22, 2020
How to Manage Repetitive Behaviors in Alzheimer's Disease
“Look for a reason behind the repetition.”— Melissa Batchelor, PhD, RN, FNP, FAAN
Are you wondering why a person with dementia develops repetitive behaviors like asking you the same question, telling you the same story, or doing the same thing over and over again? Knowledge is power. In this episode, I’ll walk you through brain development, what’s lost and retained in Alzhiemer’s disease, and help you problem-solve how to manage repetitive behaviors in a person with dementia using the C3P Problem-Solving Framework to explain.
Part One of ‘How to Manage Repetitive Behaviors in Alzheimer's Disease’
To put it simply, your brain develops from the back to the front.
The back part of your brain is where your feelings and emotions are (the amygdala). The amygdala controls our emotional responses when we encounter anything threatening, and activates the sympathetic nervous system with the fight, fright, or flight response.
The front part of your brain is called your frontal lobe, and it doesn't fully develop until you're about twenty-five years old. This part of your brain is basically the “stop sign” - meaning when something comes to mind that you want to say, your frontal lobe might say, "No, don't say that quite yet (or don't say it at all)."
What happens with Alzheimer's disease is the brain loses its ability from the front to the back. So you lose your ability to control impulses, use and understand language but your emotions remain intact throughout the disease process.
“Focus on the emotion, not the behavior.” — Melissa Batchelor, PhD, RN, FNP, FAAN
To give you a visual image of what happens to the brain in Alzheimers. Imagine a grape, that's what a healthy brain looks like. When your brain is healthy, all of the messages can get back and forth without a problem. But what happens with Alzheimer's disease is the brain begins to shrink and shrivel.
Alzheimer’s disease basically turns your brain into a raisin. Imagine a raisin. There are deep crevices, and those crevices make it hard for the messages to get back and forth. This is why people lose their memory, decision-making ability, and the hardest thing is that they lose their ability to use and understand language. So our words basically end up sounding like Charlie Brown’s teacher -
So words don’t work anymore; but the person does pick up on our emotions and our non-verbal behavior. They will “mirror” us.
Part Two of ‘How to Manage Repetitive Behaviors in Alzheimer's Disease’
Let’s talk about the C3P Problem-solving Framework focused on Changing the Person, Changing the People, or Changing the Place. The reason this is important is because there isn’t one thing that will work for any specific behavior. You will have to try different things for behaviors because what works today, may not work tomorrow. You need a “bag of tricks” and a way to think through the three levels that will help you find a solution.
Change the Person (with Dementia):
Change the People (Caregiver Approach)
Be aware of the impact of your own emotions in the moment. Caregivers may get very upset that this person can't do today what they could do yesterday. Patience is essential because while that person's feelings remain intact, their ability to pick up on your feelings also remains intact. If you express feelings of being frustrated or mad, that energy is in the room and they are also going to pick up on that.
Demonstrate what you want them to do. Another part of the brain that remains intact is the ability to “mirror” us; meaning whatever emotional state we come into a room with, the person will mirror it back to us. This is also why mimicking a behavior you want the person to do works - they understand our non-verbal communication better than when we use words. Reassure the person with a calm voice and gentle touch.
Don’t use so many words. Don't argue or try to use logic; Alzheimer's affects memory, and the person may not remember he/she asked the question already.
Resistance is usually met with resistance. As caregivers, we often have our own agenda. Things we want and feel like we need to get done. Pushing our agenda on someone else is likely to be met with resistance. If we push harder, they resist harder. So if this happens in an interaction, stop pushing and it’s very likely the person with Alzheimer’s disease will stop resisting. Wait until another time and come back and try again. Flexibility is key for this one.
“Turn the action or behavior into an activity.” — Melissa Batchelor, PhD, RN, FNP, FAAN
Change the Place (Environment)
None of us can remember everything, so that might be another strategy that could help with a repetitive question.
Some behaviors do have the same solution though. One patient that I cared for a long time ago had daily repetitive verbalizations. He would get started up in the afternoon and you could hear him all over the building. When he did this, all of the staff knew it was time to take him out for a cigarette. He calmed right down after he smoked, until the next time he wanted one. And while I don’t think smoking is a great idea, in this case, it was the lesser evil than giving him a medication that would have likely caused greater harm.
If you’d like me to talk about another topic related to Alzheimer’s disease, send me a question on the “Contact Melissa” section of this website and I’ll get to it as soon as I can. Thanks for listening ~ and reading!
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (’11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.