Alzheimer’s disease can cause unpredictable shifts in personality and behavior. If your loved one is having a difficult moment, using calm language, assessing immediate wants and needs, and shifting focus can be helpful.

Alzheimer’s disease is a progressive neurodegenerative condition. It’s a leading cause of dementia, which involves significant declines in cognitive functions such as memory, learning, and reasoning.

While its exact underlying causes aren’t fully understood, Alzheimer’s is characterized by unusual protein deposits in the brain that interrupt neuron processes and communication. Over time, these protein deposits contribute to broader changes in the brain’s structure and function.

Changes in the brain can contribute to extreme shifts in personality and mood. Your loved one may no longer be able to regulate their emotions effectively, and emotional outbursts can become a form of communication when they no longer have typical communication skills.

Understanding why your loved one with Alzheimer’s experiences difficult moments is the first step toward utilizing tips to help restore calm.

People living with Alzheimer’s experience emotions fully, but the progression of the disease may affect their ability to regulate those emotions. This means your loved one may experience a variety of exaggerated emotional responses, including:

  • anger
  • sadness
  • fear
  • anxiety
  • happiness
  • excitement

According to a 2022 research review, negative emotional stimuli tend to create the most reactions in Alzheimer’s. You might notice these emotions coming out as agitation or aggression in your loved one.

Remain calm

First and foremost, staying calm, supportive, and empathetic is essential to managing difficult moments in Alzheimer’s. Remember that your loved one isn’t behaving in a certain way because they want to cause trouble, be stubborn, or be vindictive.

Punishing their actions in difficult moments or responding with a negative emotion of your own won’t change their behavior or improve the situation.

Address immediate needs and wants

When someone with Alzheimer’s cannot communicate effectively, emotions are a way for them to let you know when they’re in need. They may be experiencing pain, discomfort, hunger, or thirst, or they may need to use the restroom.

Remove environmental stressors

Difficult moments can last longer if they’re fed by stressors in the environment, such as loud noises, poor lighting, or unfamiliar people. Turning off background sounds, adjusting too-dim or too-bright lights, and adjusting the temperature can make a difference. If you can’t change the environment, it’s OK to move to another area.

Provide a security item

Comfort goes a long way toward calming a difficult moment in Alzheimer’s. Sometimes, that comfort needs to be emotional as well as physical.

A security item is an object that your loved one is familiar with and attached to. It might be an old photograph, a stuffed animal, or a favorite blanket. Giving one of these items to your loved one can help relieve feelings such as anxiety, fear, or sadness.

Move to a new activity

A change of scenery or activity can change the emotional response of someone with Alzheimer’s. If a difficult moment occurs during reading, for example, going for a walk or engaging in another way can eliminate any aspect of reading that might have been a trigger.

New activities can also be effective distractions in situations that can’t be changed, such as visits to new doctors’ offices or changes in caregiving staff.

Have “favorites” available

It’s OK to interrupt difficult moments in Alzheimer’s with something you know your loved one enjoys, such as a favorite snack or a favorite activity.

Alzheimer’s disease affects communication and language skills, but how you communicate with your loved one is also important and can either promote a sense of calm or contribute to your loved one’s stress level during difficult moments.

Here are some communication tips:

  • Show intent: Approach from the front and identify yourself. Maintain eye contact and speak clearly and slowly.
  • Listen: Don’t disregard what your loved one is saying. Allow them to express their thoughts, and validate their feelings.
  • Speak directly to your loved one: Even if you know your loved one may need a caregiver’s help to respond, speaking directly to them is a sign of respect.
  • Don’t exclude them: Even if your loved one cannot communicate effectively, it does not mean that they want to be ignored or excluded from socializing.
  • Ask permission: Continue to ask your loved one whether it’s OK for you to assist them. Respect and support their desire to be independent.
  • Be patient: Repetition of words and phrases is OK and expected in someone with Alzheimer’s. Be patient with repetition and try to respond calmly each time.
  • Keep questions and answers simple: As the ability to communicate declines, complex conversation becomes challenging. Yes-or-no questions are often easier. Ask one question at a time.
  • Explore alternative communication: If words aren’t ideal, your loved one may benefit from the use of gestures or image cards.
  • Break instructions down: Keeping directions for tasks short and simple can prevent them from becoming overwhelming.
  • Take the high road: Avoid arguing, criticizing, or correcting if your loved one says something you disagree with.

You may not always be able to predict or prevent difficult moments in Alzheimer’s. Preparing for these experiences can help you de-escalate them when the time comes.

Here are some tips on preparing for difficult moments in Alzheimer’s:

  • Learn to recognize situations that might be triggers.
  • Always have a security item on hand.
  • Keep an emergency kit with you that contains calming items, such as a stress ball or headphones for music.
  • Have a quiet, soothing place prepared where your loved one can move to.
  • Keep a list of effective distraction techniques and calming phrases.
  • Have a fresh set of your loved one’s clothes with you in case they need to change.
  • Always carry communication cards if verbal cues aren’t effective.

Signs of emotional escalation

The earlier you intervene during a difficult moment, the sooner your loved one may return to a calm state. Potential warning signs of an escalating moment include:

  • sudden shifts in energy or mood (such as becoming more emotional or withdrawing)
  • fidgeting or restlessness
  • loud vocalizations
  • rapid speech
  • agitated facial expressions (grimacing, lip pursing, frowning)
  • agitated gesturing (arm waving, fist clenching)
  • muscle tension
  • rapid breathing
  • increased repetition of words or motions
  • staring
  • shaking or trembling

The safety of both you and your loved one is a priority, and emotional outbursts in Alzheimer’s can occasionally involve aggressiveness or volatility.

Here are some safety tips to consider during these moments:

  • Validate your loved one’s feelings and offer reassurance.
  • Remove any objects that could be used to cause harm.
  • Move your loved one to a safe, quiet space as soon as possible.
  • Keep a safe distance if your loved one is being physically aggressive.
  • Call 911 if your loved one is unable to calm down or is at significant risk of injuring themselves or someone else.

What about restraint?

Physical restraint is considered a last resort in Alzheimer’s. The American Medical Association position statement on using restraint states that all people have the fundamental right to be free from unreasonable bodily restraint and that if restraint is necessary to prevent harm, it should be at the least restrictive level possible.

Your loved one’s doctor can instruct you on approved gentle holding techniques and when to apply them if your loved one is at high risk for self-harm during an outburst.

Supporting a loved one with Alzheimer’s can be demanding, especially if you’re shouldering the responsibility alone. Alzheimer’s is progressive, and function will continue to decline over time, increasing your loved one’s need for supportive care.

It’s OK to seek professional help. It might be time to include professional caregiving if any of the following situations apply:

  • You’re no longer able to respond to your loved one in a calm, supportive way, or you’re experiencing burnout.
  • Wandering, mobility issues, or memory loss is making it dangerous for your loved one to live independently.
  • Your loved one needs round-the-clock care for basic daily living tasks.
  • Outbursts are violent or aggressive and pose a risk of injury to you or your loved one.
  • Your loved one has other complex medical needs in addition to Alzheimer’s.

Caregiver burnout is real. According to a report from the Alzheimer’s Association, nearly 60% of caregivers for Alzheimer’s and other dementias report that their emotional stress is high or very high, and as many as 40% experience symptoms of depression.

Finding support during Alzheimer’s caregiving can help provide a sense of community and offer a place to share your feelings with people who understand the challenges you’re facing.

Support resources to consider if you’re a caregiver include:

Alzheimer’s disease changes the brain’s function and structure over time. Moments of heightened emotionality are common in people with this disease and are not something they can control.

Communicating calmly, considering their comfort, and having some go-to de-escalation methods prepared can help you work through difficult moments when caring for someone with Alzheimer’s.