All of this can lead to serious behavioral problems that can put Alzheimer's patients in danger. Now, University of Michigan researchers are looking for ways to help those who care for Alzheimer's patients deal with these behavioral problems and even find out what causes them.

"There's a wide range of behavioral problems that are associated with Alzheimer's disease or other dementias," says Donna Algase, Ph.D. R.N., associate professor and director of academic programs in gerontological nursing in the U-M School of Nursing. "Among them are problems with physical aggression, inappropriate vocalizations or social behaviors, and wandering behavior, where patients walk a lot and therefore are susceptible to injuries and to getting lost."

Alzheimer's disease affects about 4 million Americans -- one in every 10 adults 65 years and older. As the baby boomer generation ages, the number of people with Alzheimer's disease may rise to 14 million.

Supported by the National Institute of Nursing and National Institute of Aging, researchers at the University of Michigan School of Nursing, in collaboration with researchers in Arkansas, are in the midst of a five-year study of behavioral problems in Alzheimer's disease patients.

The study will involve about 800 people total, from 50 nursing homes in southeastern Michigan and about 25 nursing homes in Arkansas.

"The goal of our project is to identify people among those who have Alzheimer's and other dementias, who are likely to display wandering, physical aggression and disruptive vocalizations," says Algase, a faculty associate in the U-M's interdisciplinary Institute of Gerontology. "Then, within that group, we will explore what the environmental conditions and the personal conditions are under which those behaviors emerge."

Behavior problems are, at least in part, a result of the degenerative brain changes that occur in Alzheimer's sufferers.

"We cannot see those brain changes," Algase says. "They're expressed to us in the form of changes in ability to think, like memory or attention deficits, and because of those changes in ability to think, people develop behavior problems in at least two ways -- they lose the ability to control or monitor their behavior, or they are unable to stop or start a behavior they'd like to."

Different emotions may be expressed in the form of behaviors. Because people with Alzheimer's are sometimes not able to communicate well verbally, caregivers may be able to learn to recognize and understand a particular behavior that's indicative of a certain emotion.

"For example, certain restless behavior may have to do with discomfort, and if we can connect, through research, those behaviors that are indicative of that, we can relieve discomfort and mitigate the behavior," Algase says. "Or we can know the time of day, the temporal pattern that prompts this behavior, and pre-medicate someone with an analgesic, for example, to relieve that need and prevent that behavior from happening."

One of the most common behaviors in Alzheimer's, but one that is rarely addressed, is the issue of passivity or withdrawal. This symptom doesn't generate much attention because it's not an acting-out behavior.

"But, in fact, it reduces the quality of life for the person with Alzheimer's because it disengages them from the world and it is the loss of interaction with particular family members or caregivers that the caregivers find most saddening," Algase says.

Caregivers should not take problem behaviors personally, she adds.

"Caregivers should be relieved to know that difficult behaviors, while challenging, represent the most organized reaction that a demented person can make to a situation," Algase says. "In forming a response to difficult behavior, it is helpful to look at the situation from the point of view of the person with dementia. Consider how the person might have behaved in a similar situation before the dementia and provide supports that enable as much of that behavior pattern to be carried through as is possible."

The researchers' ultimate intention with the current research: "To better connect people at risk with appropriate care facilities or settings and to use those factors that precipitate the occurrence of the behavior, to design interventions that may mitigate against them."

The research may have profound implications for the care and quality of life for people with Alzheimer's.

Family members and society expend many resources to care for these individuals, Algase says. By knowing which people are at risk for certain behavioral problems, caregivers can better target the type of care facility or the type of environment that's best suited for them. This could provide cost savings for families and provide necessary supports that are now lacking.

"This research may also reduce frustration for the caregiver who can't deduce or automatically know what a behavior might mean," Algase says. "The caregiver may go through a series of trial and error and may never figure out precisely how to help the individual. It will also help us to better understand what, through their behaviors, a demented person is trying to tell us so that we can meet their needs."

Facts about Alzheimer's disease

Alzheimer's is an illness characterized by severe memory loss. However, Alzheimer's disease may also be marked by the loss of many other cognitive functions including the ability to pay attention, perceive visual cues, verbalize thoughts and act appropriately.

Currently, about 4 million people in America suffer from Alzheimer's disease. As the baby boomer generation ages, researchers predict that as many as 14 million people may develop the disease.

A wide range of behavioral problems may be brought on by Alzheimer's disease. They may include physical aggression, wandering behavior, inappropriate vocalizations or actions, withdrawal and apathy. These behavioral changes are prompted by brain changes that occur.

Alzheimer's disease typically affects those 65 years of age and older, but may affect those as young as 40.

There is no cure for Alzheimer's disease and no known way to slow the progression of the disease. - By Valerie Gliem

Related websites:

U-M Health Topics A to Z: Alzheimer's Disease

U-M Health Topics A to Z: Alzheimer's Disease -- What to do

U-M Health Topics A to Z: Alzheimer's Disease -- What happens

National Institute of Neurological Disorders and Stroke: Alzheimer's Disease

Alzheimer's Disease Education & Referral Center

Alzheimer's Association

[Contact: Valerie Gliem]

06-Jun-2001