Do you remember the old story about Dr. Jekyll and Mr. Hyde? Gentle Dr. Jekyll invents a potion to separate the good side of his personality from his darker impulses. At first, he can drink the potion and turn himself at will into his evil alter-ego, Mr. Hyde. Soon, however, Dr. Jekyll morphs into Mr. Hyde without trying—the dark side of his personality has taken over.

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Sometimes it can seem like dementia is turning a loved one into an aggressive Mr. Hyde, who bears little resemblance to the person you once knew. How can you handle these alarming changes?

Negative Personality Changes

It is important to understand that the primary cause of behavioral and personality changes in dementia patients is the process of the disease itself. While scientists do not understand why dementia patients often become aggressive, they do know that Alzheimer's and other forms of dementia profoundly alter the brain.

In the early stages of dementia, you may notice that the patient seems moody or increasingly anxious—as the dementia progresses, the person may have unexplained angry outbursts and may seem inappropriately impulsive. The patient may also seem restless, agitated or tearful in the evenings; this is called sundowning. Usually patients express aggression and agitation verbally, but they may also become physically abusive. Sometimes patients even experience hallucinations.

While some changes in personality may be irremediable, there are some steps you can take to cope with and minimize other behaviors. Common triggers of anger or aggression in dementia patients include:

  • Pain or discomfort: The person may be responding to exhaustion from lack of sleep, or uncomfortable side effects from taking multiple medications. Urinary tract infections are common in dementia patients, and can cause severe pain that the patient may not be able to describe. Sometimes, urinary tract infections may not cause pain, but may manifest themselves in other inexplicable behavioral changes, such as outbursts or wanting to sleep all day.
  • Overstimulation: Too much noise, clutter or activity may overwhelm patients with dementia.
  • Stress and confusion: Patients may respond aggressively to the confusion caused by being asked too many questions, or being given multi-step instructions. They may also react to the stress and negative feelings of overwhelmed caregivers.

How To Cope

When you are faced with difficult or aggressive behaviors, try to analyze the situation. Was the patient feeling lost or confused? Were they overwhelmed with a new situation that they felt unprepared for, or with environmental stressors like noise or unfamiliar people? Try these tips:

  • Check to see if they are in pain, hungry, thirsty, tired or soiled
  • Try to create a calming environment with minimal distractions
  • Stay calm in the situation
  • Try switching to a different activity
  • Make sure everyone stays safe. You may need to remove yourself from the room. If the patient is about to get hurt (by walking into the street, for example); you may need to be more firm with them, but try not to use physical force.

In some cases, medication may be needed, but non-drug approaches are always used first. Finally, remember to take care of yourself as the caregiver, and ask for help when you need it.