Has uncharacteristic emotional outbursts (acts angry, aggressive, or upset)
When it happens
It can happen at any time during dementia. In those who show this tendency early in the disease, it tends to continue and even escalate until some point in the severe stage. About one in four people with dementia develop paranoia, usually during the moderate stage.
Why it happens
The cause of emotional instability isn't always clear. Some personalities are more prone. Often, though, the cause is feeling frustrated, insecure, scared, upset, or in pain. Other contributing factors include dwindling language skills, disliking caregivers/aides or the living situation, or being treated with disrespect.
What you can do
Help the person feel secure. This is the number-one way you can ward off unpredictable emotional states. (It doesn't always work, but not doing this almost always invites emotional stress.)
Be attentive; don't leave the person alone for long periods. You don't want to overstimulate by bombarding the person with companionship, but regular doses of cheerful conversation and company enhance a feeling of security and being loved.
Maintain a calm environment. Turn off the television or radio if they're not being attended to, monitor children's noise (and its effect on the person), keep plants and flowers on hand.
Know that transitions can be difficult; plan carefully for a move and try to make the new environment match the old in terms of furnishings or familiar faces. Provide extra time and reassurance during outings.
Learn to recognize the cues that the person's emotional state is changing. Some people grow red in the face or tremble; others become more quarrelsome or agitated.
If you sense agitation mounting, try stepping back. Count to 10 or 15 from another room or somewhere apart where you can keep an eye on things, and then try again. Keep to a routine schedule; predictability is very soothing.
Try distracting an upset person with tried-and-true favorites: a tape of preferred music, a cherished blanket or other comfort object, a sweet snack such as ice cream.