My husband has Alzheimer's and his mood swings are difficult to deal with!

A fellow caregiver asked...

My husband is in the early stage of Alzheimer and the main problem at this time is mood change. He takes Aricept for memory help but his mood eruptions at the least little thing is something I haven't been told how to deal with. Any ideas will be so appreciated.

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

The physical and chemical changes in the brains of people with Alzheimer's often affect mood, energy and spirit. Serious mood swings and personality changes are common. This is true of other dementias as well, especially Frontotemporal Dementia, which damages the frontal and temporal lobes of the brain, areas that affect judgment, moods, language and behavior control.

The early stage of Alzheimer's is typically the most stressful for the person with the disease as well as caregivers and family. The person in the early stage of the disease is powerless as his world changes and his self-determination slips away. It's no wonder he experiences mood swings, some may even be bordering on depression. At this point your husband is aware of his decline. He's no longer able to perform many of the things that made him feel accomplished. His confusion and forgetfulness may feel like failure to him. His generation was indoctrinated with a "stiff upper lip" approach to feelings, so he may not be able to express his fears to you except through these explosions.

Now, knowing this does not make your life any easier. One thing is to understand logically what's happening; quite another to deal with your own emotions. These outbursts feel like personal attacks, and yet it's important not to take any of them personally. Try to remember that it's the disease acting out and do your best to change the situation into something positive. This is important, because feelings, good and bad, linger much longer in people with dementia and Alzheimer's. When cognitively able people experience sadness or grief, strong feelings fade pretty quickly. However, in people with dementia, these feelings last a lot longer, often unchanged in intensity. Sadness and anger tend to linger longer than happy and joyful feelings. With that in mind, you can see the importance of keeping him in a positive space. When he has one of his outbursts, you can validate his anxiety with a simple remark: "It sounds like you're really upset." Before he has a chance to pursue his complaints, offer him an alternative. This could be a bowl of ice cream or a request to help you with something that he used to do particularly well, which allows you to compliment him, boosting his ego.

The most important piece of advice sounds a lot easier than it is: DON'T REACT TO THE ATTACKS, don't justify or explain, and don't try to reason - - - and above all, DON'T ARGUE. Reacting or arguing will only escalate the situation. Instead, you may validate his expression briefly, but quickly change the subject to something unrelated to the subject of his rage.
If it's a particularly intense event or your first attempt fails, pretend that you must use the bathroom immediately and exit the room. When you re-enter, be smiling and cheerful as you ignore his ranting and present him with an enticing diversion.

A couple of typical scenarios and suggestions on how to handle them: He mentions a particular gadget and yells at you, "I've gotta have it. It's mine! You stole it!" This particular item was thrown out years ago, but if you try to convince him of that, he won't believe you and you'll probably only agitate him even more. Instead, you may answer like this, "I'm right in the middle of something, but in a few minutes I'll be glad to help you look for it. - Oh, you know what? The dog probably needs water. Would you mind checking?" You have validated his notion, but immediately diverted with something you know he'll be interested in.

Another scenario: You enter the room and he greets you with an accusation, "Where have you been? Why did you leave me here all alone? You said you'd be right back. You lied."

People with Alzheimer's often lose the sense of time and space; when you've been out of sight, your husband may not be able to gauge how long you've been gone. Two minutes may feel like an hour to him. However trying to "set him straight" is an exercise in futility. Instead, you may simply say, "I'm sorry I took so long. I'm so glad you waited for me. Thank you. (And then the diversion:) "“ I'm starved. How about our favorite grilled cheese sandwiches for lunch?"

In the two examples above you've deflected his outbursts without accusing him of lying. Thus you have maintained his dignity. As much as possible use compliments and let him know that you're happy to be there with him. With practice, this approach will become second nature to you. Your husband will reach a point in the mid stage when he's no longer aware of his condition. He will be living in the moment and with your positive attitude you can help him make the moments special and your own life much easier.

A few rules of thumb:



"¢ ASK FOR HELP(don't worry if he's not really able "“ it's the thought that counts)


"¢ Humor, laughter, music and physical activity are very important

And for you:

"¢ RESPITE (ask friends and family to step in)

"¢ JOIN A SUPPORT GROUP (contact your local Alzheimer's Association "“

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