Alzheimer

The most common form of dementia, Alzheimer's disease is a neurodegenerative syndrome, characterized by the gradual and irreversible loss of cognitive function, which typically affects the elderly. The most characteristic symptoms of Alzheimer's are memory deficits, language problems, personality changes, mood swings (episodes of aggression, psychosis, paranoia, etc.), lack of initiative, confusion, disorientation, and loss of reasoning and judgment skills.

Experts believe that Alzheimer's disease is the result of a combination of factors, including genetics, lifestyle, family history of the disease, and environmental factors.

The evidence on the pathophysiology of this form of dementia is clear: the patient's brain undergoes a process of atrophy and extra- and intracellularly accumulates protein aggregates, which seem to affect the survival and function of neurons.

What are the behavioral symptoms?

Many people who have dealt with people with Alzheimer's say that behavioral changes are the most distressing aspect of the disease.

The main cause of behavioral disorders is the progressive deterioration of brain cells; Environmental factors and any medical conditions that can add up over time also contribute.

In the early stages, Alzheimer's patients may experience changes in behavior and personality, such as:

• Irritability;

• Anxiety;

• Depression.

Subsequently, they may also develop:

• Aggression and anger;

• Anxiety and agitation;

• General emotional distress;

• Violent physical and verbal reactions;

• Restlessness, frenetic pace, shredding paper or tissues;

• Hallucinations (seeing, hearing, or feeling things that don't really exist);

• Delusions (firm belief in things that are not true);

• Sleep problems.

Often, behavioral symptoms are triggered by events or changes that affect the environment in which the Alzheimer's patient lives; The latter, in the face of such changes, develops new fears and struggles further to make sense of an already confused world.

The classic situations that act as "triggers" of behavioral symptoms are:

• Transfer to a new residence or nursing home;

• Changes in the family environment or caregiver modalities;

• Hospitalization;

• Requests, such as changing clothes or bathing.

Identifying the cause of the behavioral symptom is often helpful in figuring out what is the best approach to address the problem.

Non-pharmacological therapies

Non-pharmacological therapies designed to manage behavioral symptoms promote the patient's physical and emotional comfort.

Their implementation is, of course, up to the caregiver or staff of the nursing home where the person with Alzheimer's resides.

Most non-pharmacological approaches aim to identify and address those needs that the Alzheimer's patient has difficulty expressing due to the progression of the disease.

Non-pharmacological strategies should always be implemented first.

For non-pharmacological therapy to be successful, it is essential that the caregiver:

• Recognize that the person is not simply behaving in a mean or grumpy manner, but is presenting with a symptom of the disease.

• Identify the cause and understand how the symptom may relate to the person's experience with Alzheimer's.

• You change your environment to solve challenges and obstacles, in favor of greater comfort, safety and peace of mind.

The non-pharmacological strategies useful for controlling the behavioral symptoms of Alzheimer's patients are:

• Monitor the patient's personal comfort. This is a check-up aimed at assessing whether the patient has any pain, is hungry or thirsty, suffers from constipation, has to pee, is tired, suffers from any infection, etc. It is also essential to maintain an ambient temperature that is pleasant for him.

• Avoid being confrontational or starting arguments. 

• Be flexible and supportive, responding to emotions, not behavior.

• Create a peaceful environment. Avoid noise, glare, unsafe space, and too many distractions in the background, including television.

• Allow adequate rest between stimulating events.

• Provide items that instill confidence in the patient.

• Recognize requests and respond to them.

• Identify the reasons behind each behavior. If you suspect that a medication or disease is the cause, you should consult a doctor.

Pharmacological therapies

In general, pharmacological therapies are indicated in the presence of severe behavioral symptoms or in the event that there is a risk that the patient is dangerous to others.

Although some medications provide good results, medicines for the behavioral symptoms of Alzheimer's should be used with extreme caution, as they can have several side effects.

Pharmacological therapies are not an alternative to non-pharmacological ones; The latter, in fact, should be maintained forever, also because they strengthen the effects of medicines.