Alzheimer's Disease: Caring For People With Unpredictable Behavior

Alzheimer's Disease: Caring For People With Unpredictable Behavior

Challenges of caregiving for patients with Alzheimer’s disease

There are some unique challenges that a patient with Alzheimer’s disease confronts. First, the disease is quite variable. There may be times when the patient can function almost normally and then other times in which the patient may be very dependent. This is a natural part of the disease. Also, the patient's response to medications may fluctuate. There is a natural tendency for a caregiver to suspect that the patient might be unnecessarily demanding or manipulative. The caregiver may see the patient functioning normally but then assume that the patient should always be able to function normally.

Alzheimer’s disease is a progressive disorder. While medications can provide some relief of symptoms, they do not stop the progression of the disease.

Depression is very much a part of Alzheimer’s disease. Alzheimer’s symptoms and disability can be made worse by depression, so it is important to recognize the signs and symptoms of depression and help your loved one seek treatment promptly.

Caring for People with Unpredictable Behavior

The changes in the brain that are associated with Alzheimer’s disease can sometimes lead to unusual and unpredictable thinking and behavior. For example, your loved one may become anxious around family members, neighbors, or friends whom he or she may not recognize, or in situations that vary from the normal routine. The person with Alzheimer’s disease also may become suspicious and suffer from delusions (false ideas that a person firmly believes and strongly maintains in spite of contradictory evidence). He or she also may begin to withdraw from social interaction, wander, become aggressive, and/or become angry and irritable.

Following are some tips to help you manage the changes in thinking and behavior that often accompany Alzheimer’s disease:


Work to preserve your loved one’s abilities, particularly those that affect dignity (such as eating and using the toilet) rather than try to teach new skills.

Stay the course

Try to minimize any changes in the surroundings or to your loved one’s daily routine.

Keep it simple

Follow simple routines and avoid situations that require the person with Alzheimer’s disease to make decisions. Having to make choices can be very frustrating and cause anxiety for a person with Alzheimer’s disease.

Reword statements

It may help to simplify, or reword your statements if the person with Alzheimer’s disease doesn’t seem to understand. Try to be patient and supportive, especially if your loved one is confused and/or anxious.

Gently remind

Help your loved one maintain his or her orientation by naming events for the day; reminding him or her of the date, day, time, place, etc., and repeating the names of the people with whom he or she has contact.


Reassure your loved one every day, even if he or she does not respond. Use a quiet voice, and be protective and affectionate. If he or she has delusions, be reassuring rather than defensive.

Be calming

If your loved one becomes agitated or aggressive, try playing music or a video that he or she used to enjoy. Reminisce with him or her about the family, or activities he or she once enjoyed (sports, hobbies, etc.).


Do not correct or confront your loved one if he or she is upset. Choose a new activity.


Try to understand the words and gestures your loved one uses to communicate. Adapt to his or her way of communicating; don’t force your loved one to try to understand your way of communicating.

Watch medications

Be sure your loved one gets the right medications and at the right time. Watch for reactions and possible side effects of medicines, such as depression or agitation. Consult with the doctor about giving any over-the-counter medicines, because they may react with your loved one’s prescription medications and cause serious side effects.

Provide a good diet

Because the effects of dementia can be worsened by poor nutrition, be sure to provide your loved one with a nutritious diet and plenty of healthy fluids, such as water or juice.

Identify triggers

Try to identify any actions, words or situations that may "trigger" inappropriate or dangerous behavior. Document any episodes of such behavior so you can try to avoid the triggers in the future.

Adapt the environment

To minimize confusion and anxiety, adapt your loved one’s environment to his or her capabilities. Make adjustments as his or her abilities decline. If your loved one tends to wander, you may need to lock the doors, especially at night. Consider participating in the Alzheimer’s Association’s Safe-Return Program. As part of this program, the person with Alzheimer’s disease wears a bracelet with a toll-free number and code. The toll-free number may be called from anywhere in North America, and the code is used to identify the person and alert his or her family of the person’s whereabouts.

Be honest

Recognize when the person’s behavior is more than you can handle. Safety—your own and your loved one’s—must be considered at all times.

In some cases, behavioral problems—especially physical aggressiveness and delusions—may require treatment with medications, such as anti-anxiety or anti-psychotic drugs. However, these drugs can have negative side effects, including drowsiness and depression, and can further affect memory.