Why is irritability more prominent in the morning in a dementia wife?

A fellow caregiver asked...

My wife is pretty far along with dementia. Most of the time she is pleasant and in a good humor. But often she starts the day hateful and uncooperative. This passes after an hour or so. Got any suggestions?

Expert Answer

For 20 years, physical therapist Connie Lambert has worked with individuals and families with Alzheimer's disease and dementia. As founder and CEO of Our Generations, LLC, she provides specialized dementia and behavioral management training for corporations, facilities, and groups.

Even though you hear a great deal about difficult behaviors in the late afternoon and evening, it is not uncommon to see unpleasant behaviors first thing in the morning. There are many causes but three come to mind immediately:

  1. Pain and stiffness from arthritis is most prevalent in the morning and usually requires at least an hour to resolve. You may wish to arrange your morning so your wife sits calmly with her breakfast for an hour before attempting anything else. Also, you may wish to discuss this possibility with her physician.
  2. Low blood sugar levels and hunger can cause behavioral problems first thing in morning. Having breakfast or a glass of juice immediately may help improve her humor.
  3. Waking up and orienting to a new day is hard enough for those with dementia. Few demands, like dressing, bathing, brushing hair and so forth, should be required prior to sitting quietly with breakfast.

You have a very difficult job. I wish you the best as you care for your wife.
Connie Lambert, PT, CCM, PhD