Alzheimer's disease occurs as a result of changes in the human brain. Although the causes are unclear as of today the levels of chemical messengers decreasing can bring on the signs of Alzheimer's disease. Over time this can deteriorate the person's way of thinking and lead to all the stages of dementia. Alzheimer's disease is a very destructive disease that not only affects the patient but also the family of the patient.

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Mr. Scott (not his real name) is a seventy year old retired postman who lives at home with his wife.
After three years of noticeable cognitive decline, he is now moderately demented. He gets good
medical care, and is otherwise healthy. His wife has become knowledgeable about his condition,
and she has family members who visit and assist her.
Mr. Scott has not been a major behavioral problem until recently. In the past month, he has had
occasional angry outbursts. At these times, he stands up, paces, raises his voice to curse and
shout commands or demands, grabs onto someone's arm too tightly, and sometimes raises his
hand menacingly. Usually he ceases after Mrs. Scott starts to cry and begs him to stop. Mrs. Scott
is afraid he will injure her or someone else, or provoke others to hit him. She worries more than
before, and is becoming somewhat demoralized.
To understand this difficult situation, we must realize that such behavior is not a pure or inevitable
result of progressive brain impairment. Rather, it results from certain combinations of (a) brain
impairment and (b) environmental stimuli and consequences.
Because of his impaired brain function, Mr. Scott is much less able to make his needs known, to
understand accurately social situations, to tell the difference between safe and dangerous
situations, and to inhibit his emotional responses. In an ideal environment, these limitations would
be no problem, because he would never encounter ambiguous situations or experience
unpleasant emotions. In the real world, however, new or unfamiliar social situations are
unavoidable, and no caregiver can anticipate a dementia victim's every need.
While dementia predisposes victims to certain unpleasant behaviors, it is often actually the
response of caregivers that determines whether the behavior will appear. Angry outbursts often
appear to "suddenly come out of nowhere," though, in fact, they usually take from minutes to
hours to develop. Early, appropriate intervention by an attentive caregiver can often nip an
emerging problem in the bud.
The key is to develop a good sense of which of the victim's needs is going Unmet at the moment.
Based on familiarity with the dementia sufferer, his habits, and his recent schedule, the caregiver
can often make a good guess as to which need is being frustrated. Next, the caregiver takes steps
to satisfy the unmet need. She should talk reassuringly, gently but firmly separating him from the
current situation, and bringing him to wherever the unmet need can be quickly gratified. Surprise
and returned anger should be avoided.
Armed with this knowledge, Mrs. Scott began to realize that Mr. Scott's "sudden rages" usually

2. occurred during or soon after a visit by a male relative, during which he was excluded from, and
unable to understand much of, the conversation. He was therefore bored and lonely. Mr. Scott's
impaired thinking allowed him to develop the self-esteem-protecting delusion that this interloper
was having an affair with his wife.
Mrs. Scott decided to include her husband more in conversations with visitors. To assure herself
the opportunity to have private conversations, she asked visitors to come in pairs. One visitor was
therefore always available to chat with Mr. Scott. After each visit, Mrs. Scott took care to show
affection to her husband. The result was that his outbursts became very infrequent, and Mrs.
Scott's confidence returned.
Example 2
Mrs. Reynolds is a seventy-eight-year-old widow living alone in an apartment building for able-
bodied elderly persons. Mild dementia has been present for one year. She is maintaining a good
level of social interaction, but recently those around her have noticed her body odor and that she
looks unwashed and unkempt. Yet Mrs. Reynolds's appetite, mood, orientation, and other
behaviors are not deteriorating.
This is a relatively straightforward example of a behavioral deficit resulting from inadequate
environmental input. The staff's optimal approach is to assume that Mrs. Reynolds (a) has not lost
the ability to perform personal hygiene activities, but (b) has lost the ability, at least temporarily, to
remember on her own to perform them. Intervention consists of building two elements into Mrs.
Reynolds's day. First are stimuli that encourage washing, such as prompts, requests, reminders,
opportunities, and offers of assistance. Second are positive consequences that reward her for
washing, such as praise, compliments, affection, and words of appreciation or admiration.
Example 3
Mrs. Hawthorne is a seventy-year-old, mildly demented female nursing home resident. Though
often observed walking around her room, she quickly sits down whenever staff enter her quarters,
insists that she can not walk, and demands to be transported in a wheelchair. When staff try to
help her to stand or walk, she acts lame, like "dead weight." When the maintenance man came to
fix her sink, she slid from the bed to the floor three times, each time pleading with him until he
lifted her (again, like "dead weight") back onto her bed.
As was true with Mrs. Reynolds, an explicit program of prompting and rewarding the deficient but
desired behavior (walking unassisted) is in order. It is often difficult, however, to find something
that is rewarding to people like Mrs. Hawthorne. Though her behavior communicates great
dependency, she often seems depressed and claims to have no interest in anything.
In such cases, remember the Premeack principle which states that the privilege to engage in
preferred activities may be used to reinforce less preferred behaviors. Mrs. Hawthorne very much
enjoys her son's weekly visits. With his cooperation, the staff informed her that she could earn
additional brief visits by him if she resumed walking to the table at mealtime. This plan was
successful, and was extended to walking to activities, and so forth.

3. -RANJEET-
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Learn more information about Alzheimer's disease, signs and symptoms, diagnosis and treatment
at:
http://www.trackads.biz/link/alzheimerdisease
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