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Jill Walton
Some of the behavioural changes that accompany a diagnosis of frontotemporal dementia can be difficult to adapt to and manage.
Personality change
Along with the obsessions, speech problems and adherence to strict routines, aggression and disinhibition can be difficult to manage both inside and outside the home.
People may find it useful to carry our credit card sized cards to show/give to members of the public.The card states:-
This person has a brain disease. There may be problems with speech, behaviour and confusion. Your help and patience would be appreciated.
Triggers
Working on the premise that ‘prevention is better than cure’ it is useful to look for the triggers that pre-empt particular behaviours. Can a cause be determined and managed?
Potential causes may be:
Medical
These include:
- Reaction to medication, in particular the drugs prescribed for Alzheimers’ disease
- Reaction to infection, e.g.: urinary or respiratory tract
- Pain. It is important to try and identify whether pain is the trigger for a particular behaviour. It may be helpful to keep an incident chart in an attempt to identify a trigger. In one case, badly fitting dentures had caused ulcerated gums which meant any attempt to eat was incredibly painful. This pain translated into aggressive behaviour at meal times but was resolved by dealing with the cause.
Environmental
This includes anything that impacts upon the senses:
- Too much noise or too many people
- Intrusion of personal space
- Frustration due to change of routine, lack of communication
- Loss of impulse control
- The need to control [ often hiding incompetence with accusations]
- Over sensitivity and reaction to touch
Avoid making matters worse
It helps if family, friends and carers are not confrontational and do not take personal offence or raise their voice. Hurrying or crowding heightens feelings of threat and alarm.
Try to avoid reacting adversely or trying to reason with the person with the diagnosis. These diagnoses make it difficult for people to follow logic in the way they may previously have been able to do.
Dealing with the problem
Adapting to and managing these changes in behaviour may be helped by the following approaches:
- Stay calm, respect personal space and be reassuring.
- Keep a sense of humour.
- Use distraction techniques. Refocus – perhaps with a change of subject or treat.
- Music can sometimes provide a helpful distraction.
- Keep decision making to a minimum. Avoid open ended questions.
- Try to find purposeful activities, including exercise where appropriate.
- Be aware that you may need to actively initiate activities. People with these diagnoses often find it difficult to start an activity, but will take part once its happening.
- Accommodate routines, behaviour and desires wherever possible.
- Assess the risk, and decide whether this is an issue you need to challenge or not. If no harm can come, maybe it is safer to let the behaviour run its course. Only take on the issues you ‘need to win’!
Conclusion
Be prepared where possible to walk away from the situation, to try later, and be flexible.