Is baby-like behavior normal in end-stage Alzheimer's?

Linda pitts asked...

My mother is in the final stages of Alzheimer's. She is totally baby-like. She howls alot. Is that normal?

Expert Answer

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

It is not unusual to witness childlike behavior in the end-stage of Alzheimer's (AD). Folks with this disease who manifest verbal actions reminiscent of babies generally fall into one of two categories. It is not difficult to uncover the trigger for your mom's 'howling' if you ask yourself the following questions.

The first question is: when you are close enough to get her attention and speak gently to her, does she become more relaxed and does she cease making noise?

The second question is: when you are close enough to get her attention, does her behavior remain the same and does she continue the howling?

If the answer to the first question is "yes" then you may rest assured that the howling is a need for attention, either human contact or mechanical such as a radio playing music that is familiar to her from earlier days. Some classical and some instrumental New Age music works quite well. Many families have successfully used large padded ear phones with recorded readings of once-familiar stories or rhyming poetry; Dr Seuss is a favorite! This seems to work best when a family member is the reader. You can also introduce CD's or cassettes that play religious services or ethnic recordings. The goal is to refocus her on pleasant sounds that induce comfortable memories while negating the unpleasant behavior.

Often, the introduction of a soft stuffed animal or baby doll help to calm & comfort the patient. Although this may seem demeaning to some readers, it has proved to be a source of great comfort to the AD population.

Check the environment for cues into why she is making this continuous sound. Is there something frightening her? Perhaps shadows from a window that may seem human to someone with AD. Is there a background noise that may be bothersome? The hum of a heater or air-conditioner. We, the caregivers, may not identify these familiar sounds as disruptive but she may feel an assault to the world she now lives in. Active consideration from another human being usually halts the negative behavior as the AD person is comforted with the added attention. Perhaps howling is the only way she has of expressing a need such as hunger or thirst, heat or chill or the desire for companionship.

If you answered "yes" to the second question then you can most likely assume it is not a need for attention that is causing her to make this continuous noise. There may be an underlying physical or medical problem that is not assuaged by attention. Because her communication system has broken down, howling may be her only way of shutting out the world around her. If your added attention or calming background does not change this behavior, I strongly suggest you seek medical attention through your family physician or the Visiting Nurse Association in your area. The most common ailments that lead to this baby-like behavior in end-stage Alzheimer's are: * urinary tract infection, * pain from arthritis or other such maladies, * ear pain, * digestive problems * constipation

When you are able to identify the cause of this noisy communication, whether it is a need for attention or a medical issue, you will be able to lessen the behavior and hopefully stop it altogether.

Be sure to take care of you!