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Behavioral Manifestations of Alzheimer's Dementia by: Michael G. Rayel, MD Alzheimer's Dementia has a combination of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor activity problem, and impairment in executive functioning (e.g. planning, abstract reasoning, and organizing). As the disease advances, the cognitive decline becomes associated with behavioral manifestations. What are these behavioral manifestations of dementia? Behavioral syndromes in Alzheimer's can be grouped into two categories: psychological and behavioral. Major psychological syndromes consist of depression, anxiety, delusions, and hallucinations. Depression in dementia is very common. Up to about 87% of patients develop some form of depression. It is characterized by tearfulness or crying episodes, feelings of sadness, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, poor energy, and thoughts of death. Irritability is also common. Depression can occur even in the early or mild phase of the illness. About 50% of demented patients show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble. Moreover, many patients with dementia may experience hallucinations. Most of these hallucinations are visual — seeing strangers in the house, an animal or insects in the living room, people in the bedroom or on top of the TV set. Occasionally, auditory hallucinations may be experienced — hearing footsteps or knocking on the door or even people singing church hymns. Regarding major behavioral syndromes associated with dementia, these problems include agitation, verbal outbursts, repetitive behavior, wandering, and aggression or even violence. Agitation can be manifested by pacing back and forth, restlessness, and inability to sit still. Verbal outbursts consist of day-long screaming or occasional yelling at someone. Repetitive behavior is manifested by closing and opening a closet or a purse or a drawer. Asking questions repetitively for instance about a relative's visit is very common. Wandering can happen especially at the late stages of the illness. If doors are left unlock, some patients wander away from the house. Hence, safety level becomes an issue. Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. A gentleman for example hit the wall with a cane and broke the window by smashing a chair. Although difficult to deal with, most of these behavioral consequences of dementia can be treated especially if recognized and addressed early.
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