1. Anything can be misconstrued as threatening.

Due to brain damage the ability to evaluate situations is greatly diminished in a person who suffers from Alz. or some form of dementia. Because of this, their reality takes on a different view and anything that is frightening to them can be misconstrued as dangerous. Some Alz. people will respond with aggression if they think their life and well-being is being threatened and even the most placid person can become combative. Combine with that the anxiety from not knowing where they are, being surrounded by strangers and in an environment they are not familiar with, can result in an emotional eruption. ALWAYS approach an Alz. victim with caution. Keep the situation as unhurried as possible. Key in on their behaviors. Do they appear anxious, are they pacing...are they shouting or acting defensive? If so, they are viewing the situation as dangerous and are quite capable of reacting violently. (how to handle this will be discussed further down).

2. Never assume everyone's reactions will be the same just because they all suffer from Alzheimer's Disease.

Each person who suffers from Alz. disease behaves and responds differently. Just because one Alz. person reacts one way, there is no guarantee the next one will behave in the same way. Although each suffer from the same symptoms of Alz. not everyone suffers the same severity. Some victims may simply withdraw into themselves if the situation becomes to much for them to handle, while others may react the exact opposite. Always view each person as an individual with Alz. and never assume they will act or react the same way.

3. Evaluate the situation constantly. Moods, reactions and responses can change in the blink of an eye.
Even to experts, Alzheimer's can be the master of manipulations. One moment it can lull a person into thinking everything is fine, and the next they find themselves confronting a person whose perception has changed completely. In one instant the Alz. person appears docile and placid, the next they can be suspicious, aggressive and paranoid. Some of this can be due to several things. One, is something commonly referred to as "sundowning" which is a strange occurrence that happens frequently in many Alz. people. As it sounds, sundowning occurs from late afternoon into the evening hours (although it can last much longer than that).

Things to look for:

The person may appear delusional, restless and agitated. The symptoms can range from being weepy to combative. They may see things, (i.e. hallucinations) and their suspiciousness, paranoia, confusion, and disorientation increases immensely. Many people wander away from home during sundowning because the restless is uncontrollable. The more agitated they become, the higher the anxiety level goes. If an Alz. person is known to be an active sundowner, the chances increase that the person will be more volatile during that time.

WHY? First off, fatigue. The person who is sundowning may be exhausted which heightens the level of emotional response. Secondly, the Alz. persons perception is greatly diminished and since they have no true grasp on reality, reactions may be spontaneous and eruptive. ALWAYS assess the situation (if you approach an Alz. who is showing the above symptoms) with caution. Stay out of the "strike zone" (i.e. close enough to be struck). Instead, stand back and extend your hand. If it is batted or hit, remain at a safe distance and speak to the AD person is a quiet friendly tone until they have calmed down.

4. Keep in mind the Alzheimer's persons mentality is greatly diminished.

Unfortunately those who do not deal with an Alz. person on a regular basis, does not realize what the disease does to the persons mentality. That is why I have taken the liberty of including a chart. (i.e. Correspondence of Functional Assessment Stages in Alzheimer's to Normal Development) which will give an in-depth look at the digression. Most commonly Alz. people are only judged by what they LOOK like, and no one takes into consideration that the persons mentality may be well below their ability to respond "correctly" to societies way of thinking. If you will notice on the chart, by stage 5, an Alz. persons mentality is only that of a 5 to 7 year old child. And by stage 6 it digresses from 5 years to around 30 months. THAT is the reason why people have a hard time "grasping" the responses they get from an Alz. victim. Little does anyone know that while the person may LOOK 75, beneath the silver hair, the person can only comprehend on an age level of a child.

5. Maintain eye contact with an Alz. person at all times when talking to them.

When you speak with an Alz. person, ALWAYS maintain eye contact. In doing this it will give you an accurate idea of how 'aware' the person is, and also how much the person is understanding / relating to what is being told to them.

6. Always begin each 'discussion' with this person by using their name (if you know it).

By late stage 5, the Alz. person can no longer process or retain information for longer than 5 minutes. In otherwords, whatever you say to the person, will be forgotten in a matter of minutes. That is why it is always important to start any conversation with the person by using his name as well as your own. Not only will this assure him/her that you know them, it will decrease the anxiety they may be feeling.

7. Use short simple sentences to convey your questions.

As I said above, you will be dealing with a person whose mental capabilities are greatly diminished. By remembering that their level of understanding is now child like as well as their inability to retain information, it's important to keep your questions as short and simple as possible. Keep in mind that lengthy explanations will be forgotten so try to utilize questions that can be termed in only 5 to 7 words.

8. Ask only one question at a time and allow plenty of time for them to respond.

The normal response time to answering questions is usually very short, unless it is being answered by a person with Alz. You see the process of answering a question is extremely difficult for an Alz. victim. The system in the brain mechanism does not work like ours. Many times, a person may not answer the question for several minutes...possibly even longer, depending on the brain damage. However as I mentioned above, this is another reason eye contact is so vital. It will tell you if the person has 'received' the question. If not be prepared to ask it over and over again, repeating it in the same voice, using the same words, and allowing a lot of time to let them absorb what you are saying.

9. Never assume the person understands the situation that is going on.

Most people would not think to include this hint, but in actuality it is one of the most important. You see people who have Alz. disease are great impostors. They don't look sick nor in the early stages do they even act that sick, but behind the scenes it is a different story. A very astute Alz. victim is very good at giving general innoxious answers. They can easily fool a person into believing they are very much aware of what is going on. But if the truth be told, the brain damage prevents them from really grasping the severity of situations. All to often, to the casual observer, and Alz. person can easily slip into a pattern of giving clichés answers and every indication of awareness. So listen closely to what the person is saying. You will realize that over time, the person is replying to you in very broad, general answers. If you have doubts wait a while and re-ask the question again.

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